Re Vietnamese National
Phillip Francis
Description
Collection
Title:
Re Vietnamese National
Creator:
Phillip Francis
Date:
6/3/2002
Text:
Dear listmembers,
We were referred a 15 year old Vietnamese National who was severely burnt 7
years ago resulting in significant defomity of his left limb due to massive
scarring.
In effect his L hip was abducted about 30 degrees and flexed approximately
25 degrees. In addition his L knee was in a fully flexed position and would
not extend at all. His foot was, and is, somewhat malformed, plantarflexed
about 75 degrees and with little or no passive or active doriflexion from
this position. He ambulated with a form of crutch under his near horizontal
thigh and wore a skirt as his limb could not be fitted in a pair of trousers
or shorts.
Rotary International arranged for this fellow to come to Geelong in
Australia for progressive plastic surgery to gradually release the scarred
areas and hopefully regain some function. This has been undertaken over 3
years and as you can see from the three photos included the plastic surgeons
have done a great job in restoring the limb to a much improved posture.
As a result of the long standing trauma and subsequent surgery, this fellow
has a sciatic nerve lesion resulting in no sensation or motor innovation
from halfway down the tibia and his knee strength is at best grade 2.
The left (affected) limb due to the equinus position of the foot is
approximately the same length as the contralateral limb and xrays show that
epiphyseal plates remain unfused and hence growth continues.
He was referred to us for prosthetic/orthotic management as the surgeons
would like to send him back to a town about 2 hours drive from Ho Chi Minh
City, for about 1-2 years.
The question from here is how do we maximise his function while still
ensuring that whatever is provided is durable enough to take home, is
practical, and can be modified/replaced/repaired in his homeland.
He has significant scarring still and a number of physical problems at both
the left knee and foot.
He would like to return to Vietnam and commence work as a farmer hence
durability is a major consideration.
The issues for us are:
1. Significant scarring
2. Lack of sensation and movement below the knee
3. Poor knee and hip strength
4. Probable leg length discrepancy with affected side (L) being longer than
the R.
5. The L foot is significantly wider and larger than the tibia above
We proposed to keep it simple and do an O'Connor boot type prosthesis with a
high femoral trim line incorporating a liner (proably pelite) and using a
peg type arrangement rather than a foot.
By laminating we can selectively strenghten and the peg will allow easy
ambulation over most surfaces.
As you can imagine in the 24 hours since we saw this lad we have
rationalised/debated/pontificated/fantasised etc etc and we would
appreciate any other suggestions which might help.
In addition we would appreciate advice on who might be able to help from
within Vietnam and whether it is in actual fact better to manage it from
home.
I might also add that amputation is not an option for at least 2-3 years.
Any help and advice would be appreciated.
Phillip Francis
Phillip Francis and Company
Barwon Health - Grace McKellar Centre
Ballarat Road, North Geelong 3215, AUSTRALIA.
ph 03 52792251
<Email Address Redacted>
We were referred a 15 year old Vietnamese National who was severely burnt 7
years ago resulting in significant defomity of his left limb due to massive
scarring.
In effect his L hip was abducted about 30 degrees and flexed approximately
25 degrees. In addition his L knee was in a fully flexed position and would
not extend at all. His foot was, and is, somewhat malformed, plantarflexed
about 75 degrees and with little or no passive or active doriflexion from
this position. He ambulated with a form of crutch under his near horizontal
thigh and wore a skirt as his limb could not be fitted in a pair of trousers
or shorts.
Rotary International arranged for this fellow to come to Geelong in
Australia for progressive plastic surgery to gradually release the scarred
areas and hopefully regain some function. This has been undertaken over 3
years and as you can see from the three photos included the plastic surgeons
have done a great job in restoring the limb to a much improved posture.
As a result of the long standing trauma and subsequent surgery, this fellow
has a sciatic nerve lesion resulting in no sensation or motor innovation
from halfway down the tibia and his knee strength is at best grade 2.
The left (affected) limb due to the equinus position of the foot is
approximately the same length as the contralateral limb and xrays show that
epiphyseal plates remain unfused and hence growth continues.
He was referred to us for prosthetic/orthotic management as the surgeons
would like to send him back to a town about 2 hours drive from Ho Chi Minh
City, for about 1-2 years.
The question from here is how do we maximise his function while still
ensuring that whatever is provided is durable enough to take home, is
practical, and can be modified/replaced/repaired in his homeland.
He has significant scarring still and a number of physical problems at both
the left knee and foot.
He would like to return to Vietnam and commence work as a farmer hence
durability is a major consideration.
The issues for us are:
1. Significant scarring
2. Lack of sensation and movement below the knee
3. Poor knee and hip strength
4. Probable leg length discrepancy with affected side (L) being longer than
the R.
5. The L foot is significantly wider and larger than the tibia above
We proposed to keep it simple and do an O'Connor boot type prosthesis with a
high femoral trim line incorporating a liner (proably pelite) and using a
peg type arrangement rather than a foot.
By laminating we can selectively strenghten and the peg will allow easy
ambulation over most surfaces.
As you can imagine in the 24 hours since we saw this lad we have
rationalised/debated/pontificated/fantasised etc etc and we would
appreciate any other suggestions which might help.
In addition we would appreciate advice on who might be able to help from
within Vietnam and whether it is in actual fact better to manage it from
home.
I might also add that amputation is not an option for at least 2-3 years.
Any help and advice would be appreciated.
Phillip Francis
Phillip Francis and Company
Barwon Health - Grace McKellar Centre
Ballarat Road, North Geelong 3215, AUSTRALIA.
ph 03 52792251
<Email Address Redacted>
Citation
Phillip Francis, “Re Vietnamese National,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/219142.
