Complex limb trauma with fracture, tissue loss, crushing and vessel/nerve damage require the combined expertise of orthopedic-trauma surgeons and plastic surgeons. Many cases which otherwise would end in amputation, can be salvaged by such ortho-plastic team approach.
Non-healing of fractures and exposure of bone is most common in the leg area where the bone or the steel plates used to fix the fracture may get exposed. Usually there is a shortage of soft tissue in this area and only bone fixation will not be sufficient to heal the wound. Often flaps and other plastic surgery techniques are needed to provide a viable cover tissue.
Unfortunately there is often great delay in referring such cases to a plastic surgeon. Valuable time is lost trying various dressings with a heavy dose of ‘hope’. Early involvement of a plastic surgeon can make a big impact on the speed of recovery and also helps to reduce overall cost, suffering and time off work. Plastic surgeons bring to this field their special knowledge and experience of tissue healing. They know what works and what would not.
Many techniques are used. One may use skin flaps to cover the bone and ensure optimum conditions for healing. One may use grafts in the less critical areas to reduce the wound burden. Special techniques like Vacuum dressings [V.A.C technology KCI International] may also be used to prepare the wound; in fact VAC has made a tremendous change to the fate of such complex wounds.
Where there is a loss of bone substance, plastic surgery techniques can move living bone into the wound area to bridge the gap. Such revolutionary methods have already become the standard of care in good centers; however it is not uncommon to see great delay before such cases are brought to the plastic surgeon’s notice. Several such cases have been treated by Dr. Mohan here in Dubai with successful outcomes [see photo gallery for some examples].