Fourteen-year outcome of unilateral leg replantation after bilateral lower leg and unilateral upper extremity amputation following traumatic injury

In cases of traumatic major extremity amputations, particularly in the lower extremity, every stage-ranging from decision-making to implementation and outcomes-remains a topic of debate. Managing major amputation cases with high mortality rates is extremely challenging both during the injury and treatment processes. We present a rare and severe case of a 30-year-old patient who sustained injuries from a concrete machine, resulting in bilateral lower extremity amputations and a unilateral proximal arm amputation. We successfully performed a replantation at the proximal ankle level on one side. In our patient, who has been followed for 14 years, we achieved a satisfactory outcome through meticulous surgical intervention, evaluated using the AOFAS and Maryland foot scores. We attained a limb with intact plantar sensation and near-complete range of motion in the ankle and toe joints. Although the clinical application of the MESS score has established criteria for replantation indications in traumatic amputation cases, we believe that there can be relative indications for limb salvage, especially in instances of multiple traumatic amputations, particularly bilateral lower extremity amputations. Therefore, in such injuries, the patient's life should be prioritized initially. Subsequently, at least one amputated extremity and its stump should be thoroughly evaluated. Rather than opting for stump closure, we advocate for attempting replantation.