gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Bilateral lower limb amputation – Case report

Meeting Abstract

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm150

doi: 10.3205/11esm150, urn:nbn:de:0183-11esm1505

Published: October 24, 2011

© 2011 Knezevic et al.
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Outline

Text

Objective: Had been to examine and emphasize the complexities of prosthetic rehabilitation in bilateral lower limb amputees.

Material/Methods: A patient V.V. (age 23) suffered traumatic bilateral lower limb amputation at work whereby his legs got caught in a machine. The accident took place on the 27th of October 2010. He was taken to emergency via emergency medical service. Unfortunately, it was necessary for the right lower extremity to be reamputated at the transfemoral level. As well, the left lower limb had to be reamputated at the high transtibial level. Even though the amputations were made at a higher level, skin defects were severe, and he was transferred to the plastic surgery clinic where skin transplantation was performed. The patient was treated at the plastic surgery clinic until the 12th of January when he was transferred to the Clinic for medical rehabilitation. Preprosthetic rehabilitation commenced during inpatient treatment at the surgical ward. At the time of admission at the clinic for medical rehabilitation, the patient underwent detailed clinical and psychological assessments. Upon routine ECG monitoring we discovered a right bundle branch block with left axis deviation, infrequently premature ventricular contractions were recorded as well. We consulted a cardiologist who allowed prosthetic rehabilitation. The right (transfemoral) residual limb was adequate for prosthetic fitting (Figure 1 [Fig. 1]). There was breakdown of transplanted skin on the left (transtibial) residual limb (Figure 2 [Fig. 2]). We had to wait for the heeling process to conclude. Majority of the left residual limb was actually scar tissue. The length of the left residual limb was 13 cm (measured from medial tibial plateau). Despite physical therapy, flexion knee contracture was present (extension at left knee was -25o). Muscle strength of the upper and lower limbs was satisfactory. Prosthetic team concluded that prosthetic rehabilitation is possible and desirable. We decided to prescribe prosthesis for the right limb while healing process was ongoing on the left limb. We kept in mind the psychological issues concerning the delayed prosthetic prescription. On March 3rd, 2011 the above-knee prosthesis was delivered. Prosthetic fittings and training began. We achieved simple standing at the parallel bars. Knee contracture decreased and extension improved to -5o. Prosthetic fittings and training went without complications. Bellow-knee prosthesis was made following a consultation with the plastic surgeon. He agreed that the left residual limb was healed at its maximum restoration. Bellow-knee prosthesis was delivered on the 23rd of March 2011. Left bellow-knee residual limb was very fragile as was expected. We had to control the duration of the prosthetic wear. Careful inspection of the residual limb was made following prosthetic wear in order to prevent and detect skin breakdowns. Prosthetist was consulted several times. Socket correction was made in order to reduce pressure to vulnerable parts of the residual limb that were noticed. Fortunately, careful increase of prosthetic wear time together with socket corrections prevented additional damages to the residual limb (Figure 3 [Fig. 3]).

Results: Three months following inpatient rehabilitation treatment the patient is able to walk with two lower limb prosthetics and the aid of two fore-arm crutches (Figure 4 [Fig. 4]). He is capable of donning and doffing prosthesis independently. The patient is able to wear the prosthesis for up to 6-7hrs daily. He performs the transfers of wheelchair-bed and vice versa independently. He performed the Timed Up & Go test and scored 26 seconds. The distance ambulated during the two minute walk test was 65 m.

Conclusion: Prosthetic fitting and gait training for bilateral lower limb amputees is challenging especially in cases where complications occur. In order to achieve success, close cooperation of all rehabilitation team members throughout all phases of prosthetic processes is crucial.


References

1.
DeLisa JA, Gans BM, Walsh NE, Bockenek WL, Frontera WR, Geiringer SR, et al. Upper and Lower Extremity Prosthetics. In: Joel A, DeLisa, eds. Physical Medicine & Rehabilitation: Principles and Practice. Philadelphia: Lippincott Williams & Wilkins; 2005.
2.
Kuiken TA, Miller L, Lipschutz R, Huang ME. Rehabilitation of People with lower limb amputation. In: Randall L, Braddom MD, eds.Physical medicine & rehabilitation. Saunders; 2006.