Case based discussion lower limb

soft tissue reconstruction

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Case based discussion lower limb

Created 3 years ago

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soft tissue reconstruction
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Slide Content
  1. SOFT TISSUE RECONSTRUCTION OF LOWER LIMB

    Slide 1 - SOFT TISSUE RECONSTRUCTION OF LOWER LIMB

  2. CASE PRESENTATION

    Slide 2 - CASE PRESENTATION

    • 43 yr male construction worker
    • Brick fell on the left shin at work
    • Open Tibia distal fracture .
    • 4 cm Degloving wound on the Antero medial aspect of distal 1/3 of Tibia .
    • No neuro vascular deficit
    • No other injuries
  3. Slide 4

    • Open fracture, clean wound, wound <1 cm in length
  4. Wound debridement and Spanning External fixation

    Slide 6 - Wound debridement and Spanning External fixation

  5. 4cm x 3cm wound, bone fragments in communication with wound: another 1cm wound over posterior calf

    Slide 8 - 4cm x 3cm wound, bone fragments in communication with wound: another 1cm wound over posterior calf

  6. Definitive treatment for fracture

    Slide 10 - Definitive treatment for fracture

  7. Slide 11

    • skin defect of 6x4cm
    • exposed bone
    • comminuted #
  8. Reverse hemi Soleus flap  with SSG

    Slide 13 - Reverse hemi Soleus flap with SSG

    • http://www.woundsresearch.com/files/wounds/photos/huuangfigure1111.jpg
    • medial part of the soleus muscle
    • for reconstruction of the medial and distal parts of the lower limb
    • narrow tibial exposures and irrigation
    • based on the posterior tibial artery perforators
  9. Post op Day 4

    Slide 17 - Post op Day 4

  10. Further readings

    Slide 18 - Further readings

    • Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: The role of local muscle flaps revisited,Pu, Lee L.Q.,Journal of Plastic, Reconstructive & Aesthetic Surgery , Volume 63 , Issue 8 , e605 - e610
    • Tobin, G.R. Hemisoleus and reversed hemisoleus flaps. Plast Reconstr Surg. 1985; 76: 87–96
    • Reddy, V. and Stevenson, T.R. Lower extremity reconstruction. Plast Reconstr Surg. 2008; 121: 1–7
    • Daigeler, A., Drucke, D., Tatar, K. et al. The pedicled gastrocnemius muscle flap: a review of 218 cases. Plast Reconstr Surg. 2009; 123: 250–257
    • Heller, L. and Levin, L.S. Lower extremity microvascular reconstruction. Plast Reconstr Surg. 2002; 108: 1029–1041