Segmental Bone Muscle and Skin Cross Leg Flap In Paediatric Patient

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  • A mangled limb in paediatric patients is a therapeutic dilemma of whether to amputate or save the limb .
  • The case study is of a 10-year-old child with high impact injury in both lower limbs.
  • Treatment plan consisted of segmental bone muscle and skin cross leg flap which successfully allowed the patient to walk using PTB prosthesis without limp.

A 10-year-old girl presented to the emergency department with a crush injury of the left foot and an open tibial fracture on the right side, after being run over by a tram. On examination, the plantar sensation and pulse were present on the right foot. However, the left foot required amputation on the level of the ankle joint, despite vacuum therapy, local and parenteral antibiotics and multiple debridements because of a deep infection.

Deep infection of left foot

In addition, a deep infection on the right side also required several surgical procedures with infected tissue debridement which resulted in bone defect with accompanying diaphysial bone defect of distal tibia on the same level.

Diaphysial bone defect with muscle and skin loss

Similarly, the remaining stump of the the skin on the left leg was not suitable to be used for prosthesis, therefore, surgeons planned a below knee amputation on selected level. The remaining distal part of the left leg, however, was intended to be used for reconstruction of segmental defect on right tibia as a donor complex.

The first stage of the reconstruction procedure was performed after determining the level of amputation. The pedicled skin segment and bone muscle on the left leg was dissected and place into the defect on the right side. The limbs were temporarily stabilised using Ilizarov fixator.

Pedicled skin segment and bone muscle on left leg

A second stage of reconstruction was performed after 4 weeks on the left side, with final formation of below knee stump and change of configuration of Ilizarov fixator on right side.

Reconfiguration of Ilizarov fixator

After 3 consecutive months, the soft tissue flap had healed. An x-ray was performed which showed a union between the transported bone segment and defect on right tibia. This allowed the removal of the external fixator.

The infected complex segmental tissue defect on right tibia and below knee stump on the left side had completely healed. The patient was eventually able to walk with no visible limp using PTB prosthesis. No growth disturbances were observed and there was no recurrence of infection even 10 years after the surgery.

References

Segmental Bone Muscle and Skin Cross Leg Flap for the Treatment of Posttraumatic Infected Segmental Bone Defect in a Child- A Case Report https://clinmedjournals.org/articles/tcr/trauma-cases-and-reviews-tcr-1-011.php?jid=tcr

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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