DOI: https://doi.org/10.22141/1608-1706.5.18.2017.114122

Case of successful reconstruction of critically damaged lower extremity

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

Abstract


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.

Keywords


microsurgical reconstruction; lower limb; combined injury

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