In acute phase post injury the main reason for failure is compromised soft tissue where we can not provide soft tissue cover for bone, vessels, nerves and tendons. Inability to do so will inevitably end with an amputation. If amputation of a leg is eminent we will will try to save the knee if possible. Function of a leg with below knee amputation is significantly better comparing to the above
knee amputation. Energy consumption is significantly smaller in below knee amputation comparing to the above knee amputation.
My personal guidance when deciding to proceed with Limb Reconstruction or amputation is based on two facts:
- patients willingness to participate and
- time to treatment completion.
It is difficult to anticipate how much time will be needed to complete the treatment. From experiences we know that open fracture of lower leg or femur with no bone or soft tissue defect will need at least one year to heal. It is not exception that even those relatively "simple" injuries take 2 years or even longer but patients are not severely restricted because of the treatment.
Injuries with bone defects are usually accompanied by soft tissue defects. Soft tissue defects usually need soft tissue transfer, local or free flap. Bone defects need either bone graft or bone transport. In either scenario months will go around without even seeing any significant progress. Unfortunately there are always complications which will slow the recovery even more.
It is not always possible to understand the injury in first day therefore will take as much time as needed before make a definitive decision. Decision to amputate someone's limb is not confirmed until all other options are exhausted.
Limb Reconstruction requires
a multidisciplinary team approach
a significant amount of patient's time and participation.
Massive massive thank you to my surgeon @mkrkovic and my team @HondaRacingCBR and @PadgettsRacing1 for getting me here and trusting me to ride and @MonsterEnergyUK @rst_motodirect @WhyArai and all my sponsors for supporting me and sorry to fans if I’ve been a bit short □— Hutchy (@tweethutchy) June 8, 2018
So today I got back on my bike after my crash in 2016 to say its been a long road is an understatement with out @mkrkovic it would have never been possible lve still got a long road ahead but I will get there I have a great family round me and great support thankyou everyone #15 pic.twitter.com/p5Pda8XSCm— Ben Wilson (@willywi15on) June 5, 2018
10/7/2015 08:19:46 am
Before I start I must say how incredibly grateful I am to Mr Krkovic, his Orthopaedic team and Mr Wallace and his Plastics team for all the hours of work they have collectively put in saving my leg. I’m not there yet but I know Mr Krkovic is doing everything in his power to give me the very best possible outcome. I am always filled with confidence every time we meet. He says most of the recovery is state of mind but if it wasn’t for his expertise and motivational approach my situation would be very different.
It’s just over a year since my accident. At the time amputation was a very real option but certainly not as far as I was concerned regardless. I was told lots of risk, hard work and a long road. I’d go as far to say more like lots of hard work a twisting, turning rollercoaster with nothing cast in stone.
Everything was going well and on plan until January when the infection struck. I wasn’t prepared for it but this was always one of the risks It’s just that I thought I was over that particular hurdle. I was admitted urgently one Friday night for, wash out, debridement and a Vac irrigation. In fact over the next few weeks K had a further five of these procedures. At the same time I started a course of IV Antibiotic therapy then once discharged I continued administering these myself at home under OPAT(Outpatient Parenteral Antibiotic Therapy). Finally the internal metal was removed and the current external fix fitted. Antibiotic therapy continued. This sounded like a real setback to me something that filled me with a great deal fear and worry. I was certainly very happy to hear the advantages. I was soon sold on the idea quickly realising that this only changed things by a few months. Nothing in the whole scheme of things. I’ve always been a positive person always up for the challenge, this is by far the biggest challenge I’ve encountered much more than cycling up any mountain or racing against the clock. One of the real plus points of the external fixator is I have a great deal more mobility. Showering as normal, bearing weight, building strength and muscle through exercise, lots of exercise. This doesn’t sound much but so far I’ve managed around a mile with crutches. After three months I was walking around the house comfortably with just one crutch and then walking free for very short distances around the house. Whilst I actually started working from home in August last year the first week in July 2015 saw me working away from home for the first time. A three hour train journey plus meetings and overnights in a hotel. Getting “back to normal”, contributing and making a difference this is so important to me…
Now the next chapter. Second week in July I’m back to Addenbrookes. Mr Krkovic again opens my leg this time he removes the cement spacer puts some more antibiotic beads in the gap, breaks my Tibia and makes ready for the turning of the screw posts. Its then over to me. Following the computer generated prescription I start turning the posts. The first five days to straighten my leg and then another 10 to close the gap which consequently shortens my leg. I must say you do need good eye sight as the numbers on the posts are very small, assistance ensures accuracy. The subsequent in my Tibia is more painful than I expected but I soon either get used to it or the pain just subsides. Next week I start turning the clickers at the bottom of my leg, one click four times per day in effect 1mm per day continuing until my leg is at the required length. It is very much so far so good and I need to just keep pushing on. I do again feel re-energised and very much focused on the end result.
8/11/2017 04:42:53 pmThank you for saving my sons leg and life. Unbelievable. Janice Lucier Daniel
23/8/2017 07:09:39 amStill doing good work mr kirkovic. You saved my leg and I'll never forget you. Thanks
20/4/2018 06:22:05 amThis is remarkable. 21cm! And to a layman, the initial injury looks like a certain amputation. Great work.
16/12/2016 07:41:51 pmThanks for the rebuild, now just to get it run in.
3/1/2017 09:11:53 pmGreat insight, good to see the patient being fully involved in procedural matters.