Heterotopic replantation after bilateral lower leg amputation

Introduction: Replantation is an established procedure in reconstructive su rgery. In a bilateral lower leg amputation attempts should e made to rescue at least one extremity, if the patients' vital conditions are stable. Pati ent and method: We report on a patient who has suffered a bilateral lower l eg amputation. Due to the complex injuries the left leg was heterotopically (cross-over) replanted to the right leg. At the left leg an above knee stu mp was created. In a second operation a soft tissue defect at the replanted extremity was covered by a free microvascular latissumus dorsi muscle flap . In addition, the tibial nerve was reconstructed. Thirteen months later th e patient is able to walk with a prosthesis for his left leg and complete w eight bearing of the replanted extremity. Discussion: Indication for replan tation depends on accompanying injuries and vital functions of the patient. Compared to a simple amputation a lower leg replantation prolongs hospital stay. delays mobilisation of the patient, and increases the necessary seco ndary procedures. However, after replantation functional outcome is mostly better than with prosthetic fitting, especially if reconstruction of sensat ion in the weight-bearing area is successful. Thus, in a bilateral amputati on movement and stability, as well as quality of life, are improved by a re planted extremity.