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Reconstruction of a Severely Crushed Leg with Interpositional Vessel Grafts and Latissimus Dorsi Flap

  • Park, Chan Woo (Department of Plastic and Reconstructive Surgery, Hanyang University School of Medicine) ;
  • Kim, Youn Hwan (Department of Plastic and Reconstructive Surgery, Hanyang University School of Medicine) ;
  • Hwang, Kyu Tae (Department of Orthopeadic Surgery, Hanyang University School of Medicine) ;
  • Kim, Jeong Tae (Department of Plastic and Reconstructive Surgery, Hanyang University School of Medicine)
  • Received : 2012.02.25
  • Accepted : 2012.05.02
  • Published : 2012.07.15

Abstract

We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.

Keywords

References

  1. Hierner R, Betz AM, Comtet JJ, et al. Decision making and results in subtotal and total lower leg amputations: reconstruction versus amputation. Microsurgery 1995;16:830-9. https://doi.org/10.1002/micr.1920161211
  2. Battiston B, Tos P, Pontini I, et al. Lower limb replantations: indications and a new scoring system. Microsurgery 2002;22:187-92. https://doi.org/10.1002/micr.22505
  3. Busse JW, Jacobs CL, Swiontkowski MF, et al. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. J Orthop Trauma 2007;21:70-6. https://doi.org/10.1097/BOT.0b013e31802cbc43
  4. Cavadas PC, Landin L, Ibanez J, et al. Infrapopliteal lower extremity replantation. Plast Reconstr Surg 2009;124:532-9. https://doi.org/10.1097/PRS.0b013e3181addc1e
  5. Nisanci M, Er E, Yildiz C, et al. Replantation of a crush amputation of distal tibia followed by lengthening with Ilizarov circular external fixator: two-year follow-up. Microsurgery 2002;22:295-9. https://doi.org/10.1002/micr.10057
  6. Nagamatsu S, Sakayama K, Kamogawa J, et al. Replantation of severed foot at the chopart joint: a case report. Foot Ankle Int 2009;30:1229-32. https://doi.org/10.3113/FAI.2009.1229
  7. Kayikcioglu A, Agaoglu G, Nasir S, et al. Crossover replantation and fillet flap coverage of the stump after ectopic implantation: a case of bilateral leg amputation. Plast Reconstr Surg 2000;106:868-73. https://doi.org/10.1097/00006534-200009020-00019
  8. Lew DH, Yun JY, Tark KC, et al. Lower leg salvage procedure in massive bone & soft tissue defects: combined free flap & ilizarov distraction osteogenesis. J Korean Soc Plast Reconstr Surg 1999;26:938-44.
  9. Helfet DL, Howey T, Sanders R, et al. Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score. Clin Orthop Relat Res 1990;(256):80-6.
  10. Rinker B, Amspacher JC, Wilson PC, et al. Subatmospheric pressure dressing as a bridge to free tissue transfer in the treatment of open tibia fractures. Plast Reconstr Surg 2008; 121:1664-73. https://doi.org/10.1097/PRS.0b013e31816a8d9d

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