EXTEND THE THRESHOLD FOR LIMB SALVAGE, A MULTIDISCIPLINARY APPROACH
Clinical case: A 48 years old indigent man, with history of smoking and chronic alcohol consumption. He was taken to the Hospital one month after leg trauma. Physical exmamination showed extensive ulcer (25x15cm) on the anteromedial aspect of the left leg, with important signs of infection, as well as significant bone exposure of the tibial shaft. No femoral or dislal pulses in the affected limb. The case was discussed with the plastic surgery team and a multidisciplinary approach was decided.
Diagnostic angiogram showed occlusion of the left external iliac and superficial femoral arteries. Patient was revascularized with aortobifemoral bypass with great saphenous vein extension to the popliteal artery. Following revascularization, there was a period wound dressing with hypochlorite and large spectrum antibiotics, followed by surgical wound cleaning. Finally, plasty of the clean injury with latissimus dorsi muscle free flap, followed by partial skin graft was performed. Patient was discharged 10 days after the plastic surgery. He remains asymptomatic, with complete healing of the injury, 6 months after hospital release.
Conclusion: In extreme cases, even after successful revascularization, the degree of tissue injury may not be compatible with a favorable healing process. In these cases, a multidisciplinary approach is the only way to avoid amputation. This case is a classic example where the evaluation and joint intervention of vascular and plastic surgery were decisive for the limb salvage of a 48-year-old man.
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