Amputation-First Step To A Better Quality Of Life

Owen A. Larson


Case History

This 13+9 yr old white female was a product of a normal pregnancy and delivery. Some dysmorphic findings at birth, including web toes, and a single crease in the palm. There were no other obvious findings.

Within the first year she developed Nevus, which were linear in function, and by the age of three the diagnosis of Epidermal Nevus Syndrome was made with Hemi-Hypertrophy on her right side compared to the left.

At the age of 3 her leg length discrepancy was 1.4 cm. Shoe lifts were used until the age of 9. By the age of 9+6 she had a discrepancy of 4.5 cm. Leg lengthening was discussed at the time.

At the age of 10 she underwent leg-lengthening procedure of her left leg. She had both femoral fixator and a tibial fixator applied at the same time. Immediately after surgery she was unable to move her toes or ankle on her own. Her foot became hypersensitive, the slightest touch would create pain.

Five days into the lengthening process daily adjustments had to be stopped do to pain. After a few days of rest the adjustment were increased to 4 times a day.

At one month post-op due to pain an exploration of the peroneal nerve was done. It was found to be intact with some bleeding and edema with resultant scar. Once again the adjustments had to be stopped due to pain. At this time a pain management specialist was called in.

Eight months post-op the lengthening procedure was aborted due to extreme pain. Only 3.5 cm had been gained. The goal had been 8 cm. Also at the time an achilles lengthening was preformed. When the cast was removed she had a significant ulcer which took considerable time to heal.

Over the next twenty-one months a number of Orthotic devices were used each prohibitive due to pain or soft tissue breakdown.

At the age of 11+9 months she underwent a medial and lateral hamstring release as well as another achilles lengthening procedure. After surgery she had lost all movement she had gained and no longer had feeling in her foot, ankle or lower leg. At the age of 13 her range of motion in the left knee is 35° flexion to 80° of flexion and 28° of valgus. The ankle is in planovalgus with the heel displaced laterally. The right knee is in 15° of flexion. 

  

She ambulated in various manners depending on the distance she had to travel. Assistive devices included wheelchair, walker and cane.

   

Solutions

More surgeries?
Medial and lateral hamstring release along with achilles lengthening and fusion of both knee and ankle, or amputation?

In April of 2003 the option of amputation was discussed. The family met with amputees of same sex and age. A meeting set with the doctor, family and Prosthetist to discuses surgery and rehab with physical therapy.

 

 

Conclusion

In September of 2003 a Transfemoral amputation was preformed. At 6 wk. post-op she was cast for a temporary Prosthesis. Fitted the following week and scheduled for physical therapy.

Currently she is an active high school student leading a better quality of life through amputation.

CP Artificial Limb Specialists Mesa, Arizona