Early microvascular reconstruction of Gustilo type III-C lower extremity wound. Case report.
Current algorithms for lower limb injuries recommend amputation for most Gustilo type III-C injuries with a limb salvage index score of 6-8 or more. Recent improvements in the timing and technique of microvascular flaps with the reduction in bone healing time as a result of better fixation devices and early bone grafting make the option of limb salvage after such severe injuries a valid and acceptable therapeutic approach. We present a case of severe shot gun injury to the leg with a limb salvage index score of 9 that was successfully salvaged by vascular reconstruction followed three days later with a microvascular osteocutaneous scapular flap anastomosed to the divided limbs of a preliminary arteriovenous fistula that had been constructed at the time of the initial vascular repair. The patient was able to walk unaided one year after the injury.
Atiyeh
B S
BS
Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Lebanon.
Hussein
M M
MM
Tayim
A M
AM
Zaatari
A M
AM
Fakih
R R
RR
D000328:Adult; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D013524:Surgical Flaps; D014948:Wounds, Gunshot / Q000601:surgery