Reconstrution of soft tissue loss in open fracture of lower limb – case report

Abstract

Purpose: to report a clinical case of open fracture of leg with tissues defect treated ortho-plastic and to analyze final outcome with regards to time taken for union and complications. Clinical case: this paper reflects one clinical case of a man of 35 years old, smoker, admitted in Emergency Department with Gustilo Andreson type IIIA open fracture in medio-distal 3rd of right calf ’s both bones with pilon fracture and soft tissues damage AO IO2. In acute stage was performed debridement, fracture fixation in external fixator and reconstruction with posterior tibial artery distal perforator flap. The donor area was covered in second stage with a split thickness skin graft harvested from the thigh. Within 4 days was performed open reduction and pilon’s internal fixation with screws. The flap was monitored hourly during first 24 hours, every 4 hours for the next 48 hours and every 8 hours for the next 72 hours. At 7 days postoperative was determined skin graft’s infection with its partial loss, being performed debridement and repeated skin grafting. After the immobilization period, that was for a total of 2 weeks, followed by offloading of 1 week, the patient started to walk using a fracture boot, being discharged for ambulatory treatment. After the 5th month, patient started a full weight bearing status without any assistant devices. At 2 months follow-up was determined fistular tibial osteitis, flap’s oedema, being underwent sequester-necrectomy and complex conservative treatment. At 5 months follow-up was determined acceptable primary union and satisfactory flap’s integration with good aesthetic appearance. Conclusion: Open fracture of leg’s bones which needs flap coverage should be treated with high priority of radical early debridement, rigid fixation, and early flap coverage. A majority of these wounds can be satisfactorily covered with local or regional flaps.