First Successful Major Lower Limb Replantation in the Penghu Islands-a Case Report

Abstract

Background:Although major limb replantation is not a life-saving procedure, it is a highly important and urgent operation, allowing for superior patient outcomes.Aim and objectives:Shorter the ischemia time, greater are the chances of a successful replantation, especially in major limb replantations.Materials and Methods:We report the case of a 36-year-old fisherman from Mainland China. His fishing craft was located across the Taiwan Strait near the Penghu archipelagos. In an accident, both his legs were crushed by a rapidly stretching boat hawser, while he was trying to put a fishing net down in the sea. His legs were amputated above the ankle and the amputated parts fell into the sea. Fortunately, the left foot could be recovered, but the right foot could not. As Mainland China was over 8 hours away, a distance too far for the injured man to travel, they contacted our hospital, only 2 hours away, to try to salvage the amputated limb. We accepted the case and instructed them on how to preserve the amputated part according to the guidelines for preserving the amputated limb. This entailed preserving the amputated part in a closed bag with rinsed and normal saline, and keeping it in a cold ischemic state in the refrigerator before reaching it to our hospital. The cold ischemic state helped us achieve successful salvage.Results:Successful replantation (lower third leg level) was performed in a 10-hour operation at the Tri-Service General Hospital Penghu Brance included only 4 days of attending physician experience in plastic surgery, as thch by a new, young, and inexperienced plastic surgeon. The surgeon's prior experiene surgeon had completed his final exam 3-4 days earlier and had recently passed the oral examination of our plastic surgery association. The below-knee amputation was performed on the contralateral limb. The patient was discharged 22 days after the operation and subsequently returned to Mainland China.Conclusion:This was the first case of a successful replantation of the major limb in Penghu and the extra-islands of Taiwan, R. O. C. Successful replantation was achieved because of a short warm ischemia time, adequate debridement, and an aggressive control of infection.