Experience in the treatment of wounds of the lower extremities with extensive traumatic detachment of skin and subcutaneous tissue]

Abstract

Presented is an experience of complex treatment of 15 patients with injuries and extensive traumatic detachment of skin and subcutaneous tissue of the lower extremities, conducted by experts of the Department of Traumatology and Orthopedics, Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia in 2012–2014. In 6 patients the severity of the injury was assessed as Degree II by Tscherne classification and Degree IIIB by Gustilio–Andersen; in 9 patients – III and IIIC, respectively. On admission primary wound debridement was performed, the limb was fixed using external fixation device (ExFixAO or Ilizarov apparatus), a vacuum drainage bandage was put over. In case of total soft tissue defects in the front lower leg, a non-free muscle flap was used on a permanent feeding pedicle from the medial abdominal belly of m. gastrocnaemius. To close tissue defects in the middle and lower third of the tibia, perfused free thoracodorsal flap was used. Tissue defects covered with granulation tissue and prepared for grafting were closed with perforated split skin autograft. Mesh wound cover was applied over the graft, and again on day 3 suction drainage was installed (in constant mode of 80 mm Hg). All patients received a vascular fluid therapy, antibiotics and anticoagulants in the treatment dosages and additionally underwent oxygenbarotherapy (5–15 sessions).