CASE REPORT

Delayed reconstruction of soft tissue defects in mangled lower extremities: A report of three cases

Agus Roy Rusly Hariantana Hamid, I Gusti Putu Hendra Sanjaya, I Made Suka Adnyana, I Gusti Ayu Putri Purwanthi , Grace Inriani Ronge, Gede Wara Samsarga

Agus Roy Rusly Hariantana Hamid
Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia

I Gusti Putu Hendra Sanjaya
Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia

I Made Suka Adnyana
Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia

I Gusti Ayu Putri Purwanthi
Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia. Email: [email protected]

Grace Inriani Ronge
Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia

Gede Wara Samsarga
Division of Plastic, Reconstructive and Aesthetic, Department of Surgery, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia
Online First: October 27, 2020 | Cite this Article
Hamid, A., Sanjaya, I., Adnyana, I., Purwanthi, I., Ronge, G., Samsarga, G. 2020. Delayed reconstruction of soft tissue defects in mangled lower extremities: A report of three cases. Bali Medical Journal 9(3): 589-595. DOI:10.15562/bmj.v9i3.2039


Background: The best timing for the soft tissue reconstruction procedure in the mangled lower extremity is still controversial. Despite the advantages of acute treatment, delayed soft tissue reconstruction are often inevitable for various reasons. This case report aims to present three cases of delayed reconstruction to treat lower extremities soft-tissue defects in mangled lower extremity following high-energy trauma.

Case Series: This study included three cases that underwent delayed reconstruction for the mangled lower extremity. The definitive reconstructions were done in 15, 30, and 60 days after injury and all cases underwent serial debridement before the definitive procedure. The reconstruction methods used were skin graft and free flap. There was no graft/flap loss observed in this study.

Conclusion: We believe that soft tissue reconstruction of mangled lower extremities following high-energy trauma may also be safely done in a delayed setting if the wound debridement is adequately done, and the basic reconstructive principles are fulfilled.

References

Zhang AY, Cholok D, Lee GK. Progressive trends in timing and imaging of lower extremity reconstruction. Plast Aesthetic Res. 2019.

Bucholz RW, Court-Brown CM, Heckman JD, Tornetta III P, Mcqueen MM, Ricci WM. Rockwood and Green’s Fractures in adults: two volumes plus integrated content website. Philadelphia: PA: Lippincott Williams & Wiilkins; 2009.

Ivanov PA, Shibaev EU, Nevedrov AV, Vlasov AP, Lasarev MP. Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures. Open Orthop J. 2016;10(1):364–74.

Naique SB, Pearse M, Nanchahal J. Management of severe open tibial fractures. The need for combined orthopaedic and plastic surgical treatment in specialist centres. J Bone Jt Surg - Ser B. 2006;88(3):351–7.

Gopal S, Giannoudis P V., Murray A, Matthews SJ, Smith RM. The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage. J Bone Jt Surg - Ser B. 2004;86(6):861–7.

Prasarn ML, Helfet DL, Kloen P. Management of the mangled extremity. Strateg Trauma Limb Reconstr. 2012;7(2):57–66.

R D. Correlations Between Degree of Limb Ischemia in MESS (Mangled Extremity Severity Score) Score in Predicting Amputation or Limb Salvage in Crush Injury at Hasan Sadikin Hospital, Bandung. Biomed J Sci Tech Res. 2017;1(6):1695–7.

Tiftikcioğlu YÖ. Delayed reconstruction of mangled lower extremities: soft tissue management. Istanbul Bilim Univ Florence Nightingale J Med. 2017;3(1):19–26.

Kadam D. Limb salvage surgery. Indian J Plast Surg. 2013;46(2):265–74.

Fischer JP, Wink JD, Nelson JA, Cleveland E, Grover R, Wu LC, et al. A retrospective review of outcomes and flap selection in free tissue transfers for complex lower extremity reconstruction. J Reconstr Microsurg. 2013;29(6):407–16.

Codina M, Lister G. Early microsurgical reconstruction of complex trauma of the extremities. Vol. 78, Plastic and Reconstructive Surgery. 1986; 285–92.

Byrd HS, Spicer TE, Cierney G. Management of open tibial fractures. Vol. 76, Plastic and Reconstructive Surgery. 1985; 719–28.

Levin LS. Early versus delayed closure of open fractures. Injury. 2007;38(8):896–9.

Yaremchuk MJ, Brumback RJ, Manson PN, Burgess AR, Poka A, Weiland AJ. Acute and Definitive Management of Traumatic Osteocutaneous Defects of the Lower Extremity. Plast Reconstr Surg. 1987;80(1):1–12.

Breugem CC, Strackee SD. Is there evidence-based guidance for timing of soft tissue coverage of grade III B tibia fractures? Int J Low Extrem Wounds. 2006;5(4):261–70.

Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: A 10-year experience with 304 consecutive cases. Vol. 29, Journal of Trauma - Injury, Infection and Critical Care. 1989; 086–94.

Chua W, Das De S, Lin WK, Kagda F, Murphy D. Early versus late flap coverage for open tibial fractures. J Orthop Surg. 2014;22(3):294–8.

Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg. 2004;114(6):1457–66.


No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0