Treatment of Multiple Foot, Ankle and Hand Bone and Soft Tissue Defects Acquired by Military Explosion Trauma: Case Report

  • Vladislavs Nikolajs Makovskis (Speaker)
  • Jevgenijs Movcans (Co-author)
  • Plotņikovs, K. (Co-author)
  • Vitalijs Pasters (Co-author)
  • Vikmanis, A. (Co-author)
  • Aleksejs Jepifanovs (Co-author)

Activity: Talk or presentation types › Poster presentation

Description

A 36-year-old man had an explosive trauma on battlefield. Multiple regions were injured, the most affected region was lateral side of left foot and ankle with extensive soft tissue and bone defect. Patients was transferred to RAKUS “Gailezers” for reconstruction treatment of bone and soft tissue defects.  First, we made debridement of the left hand thenar zone with fistula closure,  left foot defect debridement, subtalar joint arthrodesis with wire and ex-fix, bone defect was filled with PMMA with antibiotics and wound closure with NPWT dressing.  For the definitive closure of lateral foot and ankle soft tissue defect rotated peroneus brevis flap was used. Multiresistant K. Pneumoniae was presented in microbiology, because of that target oriented antibiotic therapy was started. After regular dressing distal necrosis of flap was seen. We decided to make debridement of the necrosis, that proved to be superficial, and further autodermoplasty, flap was covered by NPWT dressing. Flap and autodermoplasty was heal properly. Ex-fix and wire evacuation were made after healing of subtalar joint arthrodesis. After patient was admitted for further rehabilitation to RAKUS “Biķernieki”. After 2 month third stage surgery was done for lateral ankle instability. We made ankle joint arthrodesis with 3,5mm reconstruction plates and 6,5mm screw, with iliac crest bone autograft. Ankle joint was fixed with plaster cast for post-op immobilization. After surgery patient continued further rehabilitation. Conclusion: Explosive trauma produces unique patterns of inquiry that always complicate by infection.Treatment of explosive trauma requires step by step multiple operative interventions.Correct and aggressive debridement and target directed antibiotic therapy is the main treatment in posttraumatic infection.Definitive osteosynthesis isn't advised  as the first line treatment in case of explosion military trauma. . .. .. .
Period29 Mar 2023
Event titleRSU International Research Conference 2023: Knowledge for Use in Practice
Event typeConference
OrganiserRīga Stradiņš University
LocationRiga, LatviaShow on map
Degree of RecognitionInternational

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