558 - Taking Our First Steps: A Success Story of a Patient in Acute Rehab with Bilateral Transradial and Transtibial Amputations

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

CT

Cesar Trivino, Jr., MD

Resident
Memorial Healthcare System ( Regional Hospital South)
Miramar, Florida, United States

Co-Author(s)

HL

Hannah Levine, BS

Medical Student
Charles E. Schmidt College of Medicine at Florida Atlantic University
Wellington, Florida, United States
JJ

Jeremy Jacobs, DO

Attending
Memorial Regional Hospital South
Hollywood, Florida, United States

Case Diagnosis: Bilateral transradial and transtibial amputation secondary to vasopressors in ICU in setting of urosepsis

Case Description: A 55 year old female was found to have pyelonephritis and urosepsis secondary to nephrolithiasis. Patient was transferred to the ICU, requiring vasopressors and temporary dialysis. Evaluation with arterial duplex ultrasound revealed severe deterioration of flow at the distal forearm bilaterally, with completely occluded distal radial and ulnar arteries, and critical arterial insufficiency in the lower extremities bilaterally. Patient then underwent bilateral transtibial amputation and bilateral transradial amputation.

Discussions: Amputation is a relatively rare, yet well-known complication of sepsis. Several studies estimate the incidence of amputation in sepsis survivors to be between 0.8% - 1% and higher if on vasopressors. The majority were lower limb amputations. Post-amputation care involves prosthetics planning; fitting starts as soon as surgical wounds are healed, except in dysvascular or multitrauma patients. The use of a prosthetic limb earlier, as soon as the limb tolerates the socket, is correlated with higher functional rehabilitation outcomes and overall reduced health care costs yearly. Our patient benefited from earlier fitting while in acute inpatient rehabilitation. She donned lower limb prosthetics 6 weeks post-op, and achieved her first steps with a bilateral platform walker, thus beginning her functional independence journey as soon as possible.

Conclusions: Sepsis-associated amputation, along with other sepsis sequela, can lead to functional decline. These patients often have significant illness, and a high mortality rate. Therefore, initiating prosthetic fitting and training with patients early on is important to promote functional independence with higher success. This case report highlights the importance of an aggressive approach for prosthetic fitting and trial while in an inpatient rehabilitation setting. This opportunity, which would not have been possible in a different setting, allowed this patient to uniquely jumpstart her functional ability and enhance her quality of life.