Arch Plast Surg.  2012 Jul;39(4):417-421. 10.5999/aps.2012.39.4.417.

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

• Park CW
• Kim YH
• Hwang KT
• Kim JT

• KMID: 2120698
• DOI: http://doi.org/10.5999/aps.2012.39.4.417

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.

Keyword

Limb salvage; Negative-pressure wound therapy; Vascular grafting

MeSH Terms

Amputation
Bandages
Fibula
Fractures, Open
Free Tissue Flaps
Glycosaminoglycans
Humans
Leg
Limb Salvage
Negative-Pressure Wound Therapy
Replantation
Saphenous Vein
Skin
Tibia
Tibial Arteries
Tibial Nerve
Transplants
Vascular Grafting
Glycosaminoglycans