Case of successful reconstruction of critically damaged lower extremity

S.V. Slesarenko, P.A. Badyul, V.M. Oksimets, E.A. Kovbasa, D.S. Slesarenko


Treatment of traumatic injuries of extremities, and particularly of the calf and foot, is still one of the most challenging in clinical practice. Given relatively poor regenerative potential of this anatomical zone, adequate surgical tactics and necessity of reconstructive organ preserving interventions is under discuss. Increased number of combined, especially gunshot, injuries of lower extremities stipulates extremely relevance of rational treatment approach. There were represented a case of combined mine-blast injury of the lower extremity, with a loss of 90 % of circumference of soft tissues, and open fractures of tibia and fibula (Gustilo-Anderson IIIB type). In order to restore lost integument and vascularization of deep anatomical structures, there was applied a combination of two me­thods: microsurgical transplantation of free latissimus dorsi muscle flap with a.tibialis anterior vascular anastomoses and simultaneous split-thickness skin grafting. Bone healing was reached by compression/distraction and bone grafting technique that allowed sufficient regenerate formation in 20 weeks after trauma. There were achieved recovery, restoring of weight-bearing function of the extremity and sufficient look. Application of microsurgery technique expanded the opportunities for reconstructive interventions and allowed to restore lost soft-tissue integument and weight-bearing function of critically damaged extremity in virtue combination of methods.


microsurgical reconstruction; lower limb; combined injury


Belousov A.E. Plastic, reconstructive and aesthetic surgery / A.E. Belousov. – St.-Petersburg: Gippokrat, 1998. - 744 p.

Galich S. P. Surgical treatment of soft tissues defects of shin / S. P. Galich, A. Ju. Dabizha, A. Ju.Furmanov // Clinical surgery. - 2007. – N. 2/3. - P. 109-110.

Pshenisnov K.P. Principles of lower extremity reconstruction / K.P. Pshenisnov // Selected questions of plastic surgery. – 2003. – Vol.1, N. 9.- P.48.

A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores / M.J. Bosse, E.J. MacKenzie, J.F. Kellam [et al.] // J. Bone Joint Surg. Am. – 2001. – Vol. 83. – P.3–14.

Brumback R.J. Interobserver agreement in the classification of open fractures of the tibia: The results of a survey of two hundred and forty-five orthopaedic surgeons / R.J. Brumback, A.L. Jones // J. Bone Joint Surg. Am. – 1994. – Vol.76. – P.1162–1166.

Hong J.P. The Use of supermicrosurgery in lower extremity reconstruction: the next step in evolution / J. P. Hong // Plast. Reconstr. Surg. - 2009. – Vol. 123, N. 1. - Р.230-235.

Heller L. Lower extremity microsurgical reconstruction / L. Heller, S. Levin // Plast. Reconstr. Surg. – 2001. – Vol.108. – P.1029–1041.

Azzam W. Our experience in the management of segmental bone defects caused by gunshots. / W. Azzam, A. Atef // Int. Orthop. – 2016. – Vol. 40, N.2. – P.233-238. doi: 10.1007/s00264-015-2870-z.

Bluman E.M. War wounds of the foot and ankle: causes, characteristics, and initial management. / E.M. Bluman, J.R. Ficke, D.C. Covey // Foot Ankle Clin. – 2010. – Vol.15, N.1. – P.1-21. doi: 10.1016/j.fcl.2009.11.004. 

External fixation followed by delayed interlocking intramedullary nailing in high velocity gunshot wounds of the femur. / G.N. Dar, S.R. Tak, K.A. Kangoo, F.A. Dar [et al.] // Ulus Travma Acil Cerrahi Derg. – 2009. – Vol.15, N.6. – P.553-558.

Gustilo R.B. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures / R.B. Gustilo, R.M. Mendoza, D.N. Williams // J. Trauma. – 1984. – Vol.24. – P. 742-746.

Lessons from operation Iraqi freedom: successful subacute reconstruction of complex lower extremity battle injuries / A. R. Kumar, N. S. Grewal, T. L. Chung, J. P. Bradley // Plast. Reconstr. Surg. – 2008. – Vol.123, N 1. – P.218-229.

Limb salvage versus amputation: preliminary results of the mangled extremity severity / D.L. Helfet, T. Howey, R. Sanders, K. Johansen // Clin. Orthop. Relat. Res. – 1990. – Vol. 256. – P.80–86.

MacKenzie E.J. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP) / E.J. MacKenzie, M.J. Bosse // J. Am. Acad. Orthop. Surg. – 2006. – Vol.14. – P. 205–210.

Nahai F. Free Microvascular Muscle Flaps with Skin Graft Reconstruction of Extensive Defects of the Foot / F. Nahai // Plast. Reconstr. Surg. - 1985. – Vol.75, N5. – P.640-641.

Perineal and lower extremity reconstruction / S.T. Hollenbeck, J.D. Toranto, B.J. Taylor [et al.] // Plast. Reconstr. Surg. – 2011. – Vol.128. – P.551e–563e.

Plast. Reconstr. Surg. - 2012. - Vol.130, Issue 4. [Режим доступа: CollectionId=73]

Pu L. Reconstructive Surgery of the Lower Exremity. Vol. I. / L. Pu, J. Levine, F.-C. Wei. – St. Louis, Missouri: QMP, 2013. – 911 p.

Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps / J.K. Chan, L. Harry, G. Williams, J. Nanchahal // Plast. Reconstr. Surg. – 2012. – Vol.130, N2. – P.284-295.

Soltanian H. Current concepts in lower extremity reconstruction / H. Soltanian, R. M. Garcia, S. T. Hollenbeck // Plast. Reconstr. Surg. - 2015.-Vol. 136, N. 6. - P. 815-829.

Treatment of bone defects in war wounds: retrospective study. / P. Grubor, S. Milicevic, M. Grubor, L. Meccariello // Med. Arch. – 2015. – Vol.69, N.4. – P.260-264. doi: 10.5455/medarh.2015.69.260-264.

Zenn M.R. Reconstructive Surgery. Anatomy, technique, and clinical application / M.R. Zenn, G. Jones. - QMP, St. Louis, Missouri. — 2012. — 911 pp.

Copyright (c) 2017 TRAUMA

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта