Traumatic amputation of the lower extremity is not uncommon. The indication for lower extremity replantation may be controversial. 1,2 Replantation is considered if a sensate weightbearing extremity could be reconstructed 3-7 and in cases of bilateral amputation. [1][2][3]5,[7][8][9][10][11] Use of parts of nonreplantable tissue as "spare parts" surgery has also been described for both upper and lower extremity amputations. [12][13][14][15][16][17] Bilateral amputation of the lower extremities is challenging. Anatomic replantation is advocated, and successful replantation of both lower extremities has been reported. 1,3,9 -11 When anatomic replantation of both extremities is not possible, crossover replantation has been reported to salvage at least one extremity, because the mobilization achieved by a crossover replanted foot in combination with prosthesis is better than that with two artificial limbs, as reported by Chen and Zeng. 4 Instead of performing crossover replantation, we modified the technique by using segmental transfer of leg tissue from the contralateral amputated limb to salvage one extremity. This modification in technique, which we used in the two cases reported in this article, allowed for "ipsilateral orthotopic replantation" of the foot using vessels in the transferred segment as flow-through vessels to reconstruct the vascular architecture of the salvaged extremity with revascularization of the foot. It also restored nearly normal anatomy of the salvaged extremity.
CASE REPORTS
Case 1In April of 2001, a 32-year-old man presented with massive injuries to both lower extremities after being run over by a train. His left lower extremity was totally amputated and his right foot was subtotally amputated (Fig. 1). No additional injury was noted, and the patient was in hypovolemic shock. Intensive therapy to compensate for blood and fluid loss was started immediately. After 2½ hours of ischemia time, the patient was taken for operation. After the right lower extremity wound was débrided and cleaned, the tibia and fibula were shortened by 10 cm, with loss of ankle mortise. The continuity of the Achilles tendon, the tibialis anterior, tibialis posterior, and flexor hallucis longus muscles, and the posttibial nerve were intact (Fig. 2). Débridement of the right foot resulted in exposure of the ankle joint; the articular surface of the talus was intact (Fig. 2). Orthotopic replantation of the right foot was planned with cross-over segmental transfer of the lower third of the leg with ankle mortise from the amputated left lower extremity. Anatomic replantation of the left lower extremity was not possible because of extensive softtissue and bony damage; amputation was completed above the knee joint. The lower third of the leg and the foot were preserved (Fig. 1).In the right lower extremity, the posterior tibial artery and venae comitantes were anastomosed temporarily to the anterior tibial artery and venae comitantes (Fig. 2) to reduce the total ischemia time of the right foot. The lower third of the ...