Reattaching the two severed lower legs.

Recently, Mr. D.HH (38 years old, from Thai Binh province ) was repairing a machine when, due to carelessness, he stood inside the pressing mold of a textile pressing machine while the power switch was being turned on for testing. Immediately, the mold severed both of his lower legs. Workers in the workshop provided first aid and bandaged the wounds to stop the bleeding on the spot, after which he was immediately transferred to the Central Military Hospital 108.

At Military Central Hospital 108 , Dr. Nguyen Viet Ngoc, MD, PhD – Department of Upper Limb Trauma and Microsurgery, Orthopedic Trauma Institute, directly examined and performed the surgery . The surgery was carried out by two surgical teams working continuously for about 6 hours. After the surgery, the patient was transferred to the Intensive Care Unit for monitoring and resuscitation treatment due to significant blood loss immediately after the injury and the need for reperfusion of both lower legs after replantation.

After two days in intensive care, the patient's condition stabilized, and they were transferred back to the Department of Upper Extremity Surgery and Microsurgery for continued treatment. On the sixth day post-surgery, the patient's overall condition had recovered well, blood volume returned to normal, hemodynamics were stable; the surgical site was dry, both toes were warm and pink with good blood flow, and the dorsalis pedis-calcaneal pulse was indistinct. The prognosis was favorable.

The patient continued to receive antibiotic and anticoagulant treatment for approximately 10 days after surgery, with daily wound dressing changes, and is expected to be discharged from the hospital.

According to Dr. Nguyen Viet Ngoc, limb amputation due to workplace accidents is very common, but cases of complete amputation of both lower legs are rare, and this is the first case in Vietnam where both lower legs have been reattached. The surgery was carried out very quickly; just one hour after admission, the patient underwent basic tests and was taken to the operating room. The surgical team was quickly assembled, and the surgical method was appropriate, resulting in early reperfusion of both lower legs within 6 and 7 hours after injury (only 1-2 hours after the surgery).

According to Dr. Nguyen Viet Ngoc, for large limb amputations and multiple limb amputations in a single patient, reattachment requires very careful planning. Carelessness can be life-threatening due to reperfusion syndrome and the toxins released from the detached limb tissue. This case was meticulously planned by the surgical team, employing a sound strategy and working simultaneously with two surgical teams to minimize the reperfusion time. The surgery was successfully completed as planned. Currently, the patient's blood supply to the reattached limb is very good and stable, and they can flex their toes. The prognosis for functional recovery is good.

Text and photos: THUY NGOC

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