Farm-related amputations remain a problem in children. The injuries sustained are often severe and result in a lost in limb. This article is a retrospective review of children that sustained traumatic amputations at the Mayo Clinic between 1978 and 1992. Two hundred and fifty-nine children were included and 11 patients with 12 amputations were identified as farm-related accidents. There were eight boys and three girls with an average age of approximately eight years. The mechanism of injury was an auger (six limbs), power take off (5 limbs) and a conveyor belt (1 limb). Eight out of the 12 traumatic amputations involved the upper limb. Six limbs were amputated above the elbow and two limbs below the elbow. The remaining amputations involved the lower extremity. Operative cultures revealed a variety of organism and contaminates in all patients. Only those patients who underwent an attempted replantation developed clinical evidence of wound or deep infection. In fact, all limbs that underwent attempted replantation developed some form of clinical infection. All infections were controlled with antibiotics and debridement. Systemic infection did not occur in any patient.
Replantation was only successful in two out of six limbs. Failure replantation in the four limbs was due to vascular insufficiency, infection, or extensive soft tissue loss. Mean follow-up was eight years and six of the 11 patients required reoperation for bony overgrowth, hypertrophic bone removal, debridement, contracture release, or neuroma incision. All upper extremity amputees had a prosthetic device manufactured for them. However, only two patients used a prosthesis on a regular basis.
Management of farm-related limb amputations requires meticulous surgical debridement, antibiotic therapy and delayed wound closure. Replantation is difficult and often unsuccessful. In addition, replantation appears to increase the chances of infection. This information should be relayed to families following farm-related amputation. Replantation after farm-related injury should be approached with caution. Given the fact that most of these injuries are preventable, continued efforts with regard to education, and legislation are required.
J Pediatr Orthop