PERINATAL LIMB ISCHEMIA - ORTHOPEDIC IMPLICATIONS

Fifteen patients (16 ischemic limbs) who ultimately required amputatio n for perinatal limb ischemia were treated at The Children's Hospital of Philadelphia and the Shriners Hospital for Crippled Children in Phi ladelphia between 1980 and 1993. The average birth weight of these pat ients was 1,870 g, and the average gestational age was 30.8 weeks. Isc hemic events occurred at an average postnatal age of 5.4 weeks. The ca uses of the ischemia included (a) arterial thrombosis as a complicatio n of arterial catheterization (eight patients), (b) thromboembolism re sulting from a hypercoagulable state (five patients), (c) intravenous infiltrate (one patient), and (d) in utero arterial thrombosis (one pa tient). Amputation was required at an average postnatal age of 8.5 wee ks. The final patient, with concurrent ischemia involving the right ha nd and left leg, had complete resolution of the ischemic hand with fib rinolytic therapy alone and required only an amputation of the lower e xtremity. Eleven of the 15 patients were available for follow-up (two dead, two lost to follow-up), at an average of 4.5 years. Nine of thes e 11 patients (six lower and three upper extremities) are functioning well in prostheses. The two remaining patients are infants who will be fitted for lower-extremity prostheses when they begin to attempt to w alk.