Poster 156: Ambulation after bilateral below-knee amputations secondary to necrotizing fasciitis: a case report.

Abstract

Setting: Tertiary care hospital. Patient: A 57-year-old woman with bilateral below-knee amputations secondary to necrotizing fasciitis. Case Description: This patient was initially admitted with respiratory distress, and she eventually developed bilateral lower-extremity open wounds caused by disseminated intravascular coagulation. Subsequently, she underwent bilateral below-knee amputations secondary to necrotizing fasciitis. Multiple skin grafts were done, with 100% grafting of both amputation stumps. She was informed that she would never be able to ambulate again. At a later date, she had right elbow capsular release surgery for flexion contracture. Her right index to ring proximal interphalangeal joints had a 30° to 40° contracture, however, she was able to make a partial fist. 10 months after her amputations, she commenced comprehensive inpatient prosthetic gait training and skin care education. A total-surface bearing hydrostatic socket prosthesis with extra-thick silicone gel liners was issued for optimal shear force reduction and suspension. A single-axis dynamic foot with soft heel describes the foot component. Assessment/Results: 3 weeks after admission, the patient was able to transfer and ambulate 50ft with supervision, and she required minimal to moderate assist for donning and doffing her prosthesis. Only 1 incident of skin breakdown occurred since surgery. The patient followed up regularly in clinic and she continued to improve. Currently, the patient is ambulating independently with a cane, and she manages her prosthesis with complete independence. Discussion: This is the first reported case, to our knowledge, of successful ambulation after bilateral below-knee amputations secondary to necrotizing fasciitis requiring complete skin grafting of residual limbs. Conclusions: This case illustrates that meticulous skin care in combination with an effective prosthetic device in skin grafted amputation stumps can lead to results that exceed expectation.