Long-term result of treatment of a patient with an extensive circular soft tissue loss of the lower third of the leg (clinical case)

Abstract

A clinical example of the successful use of modern reconstructive surgery in the treatment of a patient with a severe polystructural injury of the lower extremity is described. Patient B., 18 years old, received a combined injury to the head and limbs as a result of falling under a moving train. The presented clinical observation demonstrates the possibility of successful replacement of an extensive circular defect of the lower third of the leg using sequentially free and non-free blood-supplied tissue complexes. The use of a crossed non-free sural fasciocutaneous flap to close the defect that arose after partial necrosis of a previously transplanted free blood-supplied anterolateral thigh flap made it possible to completely restore the skin of the lower third of the leg. The main advantages of this type of plastic surgery are, of course, the relative technical simplicity of the surgical intervention and the short duration of the operation. At the same time, the main disadvantage of this method of closing a wound defect on the distal parts of the lower extremity is the need to keep the patient on strict bed rest with the forced position of the legs for three weeks before cutting off the flap. Thus, the main indication for its use is the failure of previously performed reconstructive operations on the distal parts of the lower limb.