Lower Limb Trauma
Lower limb trauma has evolved to be a multi-specialty treatment modality with the advent of high velocity injuries. The element of crush and associated vessel and neural trauma now dictate the outcome of limb salvage.
Near total amputation of right big toe in a 3 year old kid with severe crush element. Big toe revascularization was done with dorsal vein graft.
An1 8 year old student post RTA with major soft tissue loss and Tibialis anterior tendon injury and open ankle joint. She underwent initial debridement and VAC application followed by definitive cover with Anterolateral thigh microvascular free flap cover along with Tibialis tendon tendon repaired with fascia lata graft.
Post-op regained full ankle function.
TENDON TRANSFERS
Tendon transfers as a secondary procedure for patients with foot-drop.
OSTEOMYELITIS
Post-op regained full ankle function. 42 year old male post RTA with open # ankle joint with communitted fracture calcaneum and distal end of fibula. He presented with an infected wound and initial debrided showed Osteomyelitis calcaneum which was debrided.
Post 3 VAC sessions underwent definitive wound cover with propeller flap
INFECTION
Pre op-
A young 26yr old mother, sustained RTA and presented with infected wound with implant in situ for # tibia-fibula. She underwent extended debridement and multiple VAC sessions till her wounds were clean and granulating.
She underwent definitive management as anterolateral thigh free microvascular flap cover.Hers is a case study on the emphasis of initial debridement and wound cover as early as possible to be the two important factors dictating the final wound management.