Replantation of Both Completely Amputated Feet: A 19-Year Follow-Up Case Report

Abstract

Traumatic bilateral complete foot amputation poses a major reconstructive challenge, with replantation rarely attempted due to poor long-term function and scoring systems like the Mangled Extremity Severity Score (MESS), where a score ≥ 7 indicates amputation. We report a case of a 44-year-old healthy male with bilateral complete foot amputations (MESS = 8) from an industrial accident. Emergency bilateral replantation was performed using a multi-team approach with radical debridement, tarsometatarsal arthrodesis, and microvascular repair. At 19 years, the patient walks independently with custom orthotics, performs all daily activities including farming, and reports high satisfaction. Radiographs confirm solid fusion; protective sensation is present. This case shows bilateral foot replantation can yield durable, excellent function despite a high MESS score, challenging its absolute predictive value. Success depends on precise technique, stable skeletal fixation, and persistent rehabilitation in a well-chosen, motivated patient. Preserved plantar sensation offers functional advantages over prosthetics in demanding jobs.