Successful Treatment of Well-Developed Accessory Lower Limb Associated with Spinal Dysraphism

Functional accessory limb arising from the buttock: a case report

BACKGROUND

Polymelia, or accessory limb, is a rare congenital abnormality with unknown etiology. Here we report the case of an infant with an accessory limb, review the diagnostic and therapeutic consideration of such cases, and highlight the potential challenges in management of an accessory limb.

CASE PRESENTATION

We report the case of a 2-month-old male with an accessory limb arising from the left buttock. The limb was sensate and mobile joints. Our diagnostic workup did not reveal associated spinal dysraphism, but a left dislocated hip was found. The limb was surgically removed, and the hip dislocation was eventually treated with open reduction, with excellent results.

CONCLUSION

This study reports a rare case of accessory limb and reviews the important considerations in the management of this condition.

CLINICAL TRIAL NUMBER

Not applicable.

Presentation of polymelia in conjugation with spinal dysraphism: A case report

INTRODUCTION AND IMPORTANCE

Polymelia is a rare congenital deformity characterized by an extra limb connected to a different part of the body. The Incidence of this condition in humans is scant but relatively higher in animals. Hereditary and genetic factors are linked to the pathogenesis of this condition, but the relationship is not clearly understood. In this article, we highlight the presentation of polymelia and the approach used to treat the patient.

CASE PRESENTATION

A 3-month-old male was brought to medical attention by his parents, who expressed concern regarding an extra limb attached to his back. He was born via spontaneous vaginal delivery after an uncomplicated pregnancy, with the only significant finding being the additional limb. After a thorough evaluation by a multidisciplinary team, he was diagnosed with Polymelia associated with spinal dysraphism. The child underwent surgery to excise the extra limb and to seal the defect in the vertebrae.

CLINICAL DISSECTION

Polymelia is associated with multiple congenital malformations. Although it can be diagnosed in the antenatal period, most cases are identified after birth. The extra limb is usually functionless, but sensation may be preserved. It may be a well-developed limb or just a bud. A comprehensive evaluation is mandatory to explore the associated hidden malformation.

CONCLUSION

The expression of polymelia differs among individual case presentations, and the related congenital abnormalities pose significant management challenges. Surgical intervention is always essential, yet some complications are inevitable.

Epidemiology and Outcome of Nontraumatic Lower Limb Amputations

BACKGROUND

In order to create a solid evidence base for the development of improved management methods, this study was performed to describe the epidemiology and outcome of nontraumatic lower limb amputations (LLAs).

METHODS

This descriptive case series was conducted over a period of 4 years. It included all patients of both sexes and all ages who underwent LLAs for nontraumatic indications.

RESULTS

There were a total of 217 patients with 136 (62.67%) men and 81(37.32%) women. The age range was 7 to 71 years, with a mean of 54.25 ± 11.49 years. The most common indication for amputation (41.47%) was diabetic foot gangrene. The most common level of amputation (48.29%) was below knee amputation.

CONCLUSION

Patients with diabetic foot gangrene, malignant tumors, and chronic neuropathic ulcers with osteomyelitis constituted the bulk of the amputees. Diabetes mellitus, obesity, and hypertension were the commonest comorbidities identified among them. Public awareness and education would ensure prompt and early health seeking at the appropriate time and help to prevent the need for major amputations in many instances. The amputees' improved reintegration into society and ability to become contributing members of society would be ensured by the provision of vigorous rehabilitation.

Heteropagus twins: six cases with systematic review and embryological insights

PURPOSE

Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described.

METHODS

Six cases of HT managed at two tertiary care teaching hospitals over the last 26 years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed.

RESULTS

Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived. On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases.

CONCLUSION

Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance.

LEVEL OF EVIDENCE

IV.

Fully developed accessory lower limb with tethered cord: Are these two anomalies related?

BACKGROUND

Spinal dysraphic anomalies may be hidden beneath grotesque cutaneous stigmata, like a fully developed accessory lower limb.

CASE DESCRIPTION

Authors describe a 4-year-old boy who had socially unacceptable malformation in form of an accessory lower limb, in addition to perfectly normal both lower limbs with underlying low-lying tethered cord. Radiological studies showed underlying tethered cord and dysraphic spinal column.

CONCLUSION

Successful surgical correction was undertaken along with detethering of cord. The present case asks for evaluation of all cutaneous stigmata over spinal regions in newborns for spinal dysraphic states.