Amputated lower limbs as a bank of organs for other organ salvage.

Abstract

Aggressive modern technologies have made it possible to attempt limb salvage in even the most extreme cases. However, it is imperative to remember that prolonged salvage attempts may lead to devastating complications. The decision-making is more problematic in patients with bilateral severely injured mangled lower limbs. In such a case, protocols like the MESS are no longer valid because of the implications of bilateral amputation. In these rare cases, we use a multi-team approach and modern micro-surgical reconstructive techniques in attempting to salvage at least one of the lower limbs. We present here our experience in six patients with bilateral mangled lower limbs where an amputated limb was the source of "spare parts" for the salvage of the contralateral limb. In each of the cases, after evaluation and planning, the harvesting of the required tissues (including skin, muscle, bone, nerve and blood vessels) from the amputated leg was performed and simultaneously, a reconstruction of the contralateral severely injured limb was done. These cases emphasize the importance of modern trauma care, not only the ability to treat multiply traumatized patients, but also the capability to execute sophisticated techniques during the acute phase of treatment with maximal cooperation between teams from different disciplines.