The following case study demonstrates how the team of the Extremities at Risk group were able to provide surgical options to a young man that underwent a 4 limb amputation following an electrical burn accident.

The patient experienced a severe electrical burn which resulted in him requiring amputation of both legs above the knee, and both arms. His left arm was amputated through the shoulder joint, and his right arm appeared to be amputated through the humerus. He was left with an extremely short residual limb on the right and none on the left.  The amputations of his arms left him with very little opportunity to be fit with upper extremity prosthetic devices.

He was referred to Dr. Robert Meier, an amputee rehabilitation specialist, and Dr. Meier recommended he have consultation by our orthopedic and plastic surgery specialists to determine if there were upper extremity reconstructive options that would allow this young man to be able to wear a prosthesis.

His x-rays revealed he did have a humeral head on right side, meaning he had a shoulder joint.  There was no humerus remaining so fitting with a prosthesis he could use was not possible in his current situation due to the bulk and weight of any prosthetic that would be helpful to him.

X-ray of right arm showing humeral head

Because he was interested in being able to use upper extremity prosthetics, the team recommended that he undergo a revision of the right extremity. The recommendation was to use an Allograft bone to lengthen his arm. This lengthening would require skin and muscle from one part of his body be moved to cover the newly lengthened arm. The ideal area with the latissimus muscle (large muscle covering his upper back).  He underwent the procedure which provided approximately 6 centimeters of length to his right arm.

Allograft attached to humeral head. Latissimus muscle flap before covering allograft.	Intraoperative picture showing the latissimus muscle flap covering the allograft.	X-ray of allograft attached to the humeral head.
Once his incisions were healed he was fit with a bilateral upper extremity prosthetic device.           Patient demonstrating movement of his right arm Patient with his upper extremity prosthesis on.    He has undergone training and rehabilitation to be able to use the upper extremity prosthesis. At the same time he learned to use his lower extremity prosthetics so he is able to walk without any assistive devices. He currently owns and runs a automobile repair shop in Denver.