Amputation of Necrotic Limbs in Children: About 35 Cases

Introduction: Amputation is a surgical procedure that involves the removal of a limb, a segment of a limb, or a protruding part. Objective: To assess the clinical, etiological, and therapeutic aspects of necrotic limbs in the pediatric surgery department of Gabriel Touré University Hospital. Methodology: This was a prospective study from January 1, 2020 to December 31, 2022, involving all children aged 0-15 years who were treated for necrotic limbs in the pediatric surgery department. Results: We collected 35 cases of necrotic limbs with a hospital frequency of 2.3%. The average age of the patients was 7.1 years. The sex ratio was 1.5. Limb gangrene was the most common reason for consultation in 45.7% of cases. The left side of the limbs was most affected in 65.7% of cases. The pelvic limb was the most affected site in 57.9% of cases. Open fracture with crushing was the most common etiology in 42.8% of cases followed by complications of traditional treatment in 22.9% of cases. The average time to treatment was 18 days. The leg was the most affected segment for pelvic limb amputation in 54.5% of cases. The arm was the most affected segment for thoracic limb amputation in 46.7% of cases. Anemia was present in 74.3% of cases. Standard limb radiography was performed in all our patients. Doppler ultrasound of the limbs revealed complete arterial occlusion in 48.6% of cases. The majority of patients underwent major amputation in 63% of cases followed by disarticulation in 37% of cases. Suppuration was the most common postoperative complication in 14.3% of cases. Crutches were the most commonly used device for locomotion in 45.7% of cases followed by prostheses in 5.7% and wheelchairs in 2.9%. Conclusion: Limb amputations remain an indication of last resort. The etiologies are multiple. Knowledge of the principles of producing a stump adapted to modern functional equipment is essential, in a multidisciplinary approach.