Bruno Livani

A case series featuring extremely short below-knee stumps.

Background: Lower limb amputations should be evaluated carefully, especially with regard to the possibility of preserving the knee joint to enable a more physiological gait and lower energy consumption. Below-knee amputations were performed immediately below the tibial tuberosity with maintenance of the insertion of the patellar tendon, resulting in very short, but functional stumps. This case study examined whether very short below-knee stumps allow a more functional gait, as compared to more proximal amputations. Case Description and Methods: Between June 2010 and June 2011, four patients had extremely short below-knee amputations, with resection of the head of the fibula at the junction and reinsertion of the collateral ligaments and structures attached to the tibia. This was followed by placement of a prosthesis with a vacuum-assisted suspension socket. Findings and Outcome: At the end of treatment, patients that underwent transtibial amputations with an extremely short stump were considered well adapted to their prosthesis and were satisfied in relation to the acquired gait patterns. Conclusion: The extremely short below-knee amputation, despite having a short lever arm should be considered as another option for lower-limb amputations, although we cannot yet assure that other patient groups undergoing this level of amputation may have the same results of the study. Clinical relevance The extremely short below-knee amputation, despite having a short lever arm should be considered as an option for lower limb amputations, as it can provide a prosthetic provision with a good functional outcome.

Pedicled sensate composite calcaneal flap to achieve full weight-bearing surface in midshaft leg amputations: case report.

Of the possible levels of amputation, transtibial amputations result in functionally excellent outcomes. However, in contrast to hind foot amputations, such as Syme and especially Boyd amputation, acute or late complications related to the amputated stump are frequent with the various described techniques. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) pedicled sensate flap with a surface that allowed full terminal weight-bearing in transtibial amputations in adults. One male patient, 66 years old with schizophrenia and chronic distal tibial osteomyelitis, underwent a leg amputation with sensate composite calcaneal flap construction. The stump was painless and able to bear total terminal weight at 12 weeks. Calcaneum tibial fusion was observed at 12-week postoperative follow-up. A below-knee prosthesis was adapted in 12 weeks, and at the 1-year follow-up, the patient was completely satisfied with the functional performance of his stump. The flap described provides proprioceptive feedback with the best bone and skin to support weight bearing. Another advantage is the possibility to use the same prosthesis commonly used in Boyd or Syme amputation due a longer arm leverage, which also allows full terminal weight-bearing. In the current study, a transtibial amputation covered with a pedicled sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong full weight-bearing terminal surface of the stump that will last a lifetime.

Amputaçäo dos membros inferiores na criança. Relato e experiência em 21 casos

Os autores apresentam os resultados de 21 pacientes, com idade media de 6 anos, submetidos a 26 amputacoes do membro inferior por malformacoes congenitas (14), infeccoes (06) e outras. Discute-se os procedimentos, as complicacoes, as vantagens e desvantagens de cada nivel de amputacao. Concluem que a amputacao na crianca continua sendo uma opcao a ser considerada, principalmente por propiciar rapida recuperacao funcional e social do paciente.

Descolamento da epífise proximal do rádio diagnosticado tardiamente: relato de caso e revisão da literatura

Os autores apresentam um caso de descolamento traumatico da epifise proximal do radio, diagnosticado 5 meses apos luxacao posterior do cotovelo, em uma crianca com 9 anos de idade. Foi realizado reducao e fixacao da epifise avascular na metafise proximal do radio e, apos 24 meses de seguimento, esta epifise encontrava-se revascularizada e o cotovelo apresentava flexao de 0-130o, pronacao de 80o e supinacao de 30o.

Pedicled Sensate Composite Calcaneal Flap in Children With Congenital Tibial Pseudoarthrosis

Background: The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait. Unfortunately, in some situations, particularly when amputation is performed conventionally, the stump is also associated with complications. Future surgical revisions are often needed, particularly in children, because of stump overgrowth. Methods: Between 2008 and 2010, three patients diagnosed with congenital pseudoarthrosis of the tibia associated with neurofibromatosis who were indicated for TT amputation with calcaneal flap after failure of all previous surgical reconstructive procedures were selected. The chosen method for osteosynthesis was an external fixator of Ilizarov. Results: At 12 weeks of follow-up, the stump had healed in all three patients, and tibiocalcaneal fusion was achieved without complications. All patients were prosthetized and had an asymptomatic gait. After a minimum follow-up of 6 years, all three cases with the pedicled sensate composite calcaneal flap still had a strong, full weight-bearing surface and have adapted easily to the conventional prosthesis, providing a painless stump with excellent functionality. Conclusion: With a 0 rate of needed revisions, all 3 cases with the pedicled sensate composite calcaneal flap preserving the hind foot still have a strong, full weight-bearing surface and have easily adapted to the conventional prosthesis, providing a painless and excellent functional stump that could last a lifetime. Level of Evidence: Level IV.