Replantation of almost completely amputated thigh with recovery

Abstract

A twenty year old woman had transection of all the structures of the distal right thigh except for the sciatic nerve, the vastus lateralis muscle, and a small strip of skin. Successful replantation with excellent functional result was attributed to several fortuitous factors: (1) most importantly, an intact sciatic nerve; (2) the youth of the patient; (3) presence of a minimal amount of collateral circulation which, although not enough to maintain the viability of the limb, perhaps bought time for the tissues during the prolonged period of ischemia. Important technical factors in replantation include: (1) careful debridement; (2) accurate anastomosis of the vein and artery; (3) adequate fasciotomies of the anterior and posterior muscle compartments of the leg; (4) adequate internal fixation of the comminuted compound fracture; (5) intravenous administration of large amounts of balanced electrolyte solution and correction of blood loss; (6) massive doses of penicillin and streptomycin.