Complex limb salvage with an orthoplastic approach: a case report

Abstract

Lower extremity trauma is an important cause of patient morbidity and disability-adjusted life years (DALYs). It also presents a significant reconstructive challenge for surgeons. Mangled extremity injuries can result in an amputation when limb salvage procedures are unsuccessful. Identifying strategies to optimize limb salvage attempts is necessary to improve postoperative outcomes. Establishing a constructive relationship between orthopaedic and plastic surgeons has been shown to be beneficial and subject to a growing interest in the trauma literature. We present the case of a 42-year-old male referred to our institution for limb salvage after sustaining severe bilateral lower extremity injuries. These included a right open Gustilo 3B tibia shaft fracture with a critical bone defect combined with a left floating knee (closed femur fracture and open Gustilo 3C tibia fracture). Bilateral tibia fracture-related infections were treated in conjunction with successful flap coverage. Following eradication of the infections, adequate soft tissue coverage and stable bony fixation, the tibia critical bone defect of close to 8 cm was treated with bone transport. Limb salvage was successful; amputation was avoided, and good function of both limbs was achieved. This manuscript shares a great clinical success in the extensive collaboration between two surgical subspecialties.