Post traumatic raw area

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hi all
here with 17 year old college girl had road traffic accident 7 days back and came now for management.
tibialis posterior and extensor hallucis longus were exposed and seem to be non viable.i would like invite opinion regarding management

suresh

 

skin graft?

 

This young lady needs a skin graft after debridement of the necrotic anterior tibial and extensor hallucis longus tendons. She should be referred to a plastic surgeon for this procedure.

 

dear kevin
if we go for both debridement of tendons and skin graft
later reconstruction will be a problem.
my plan is debridement of the tendon followed by local ratation flap cover over the tendon area and rest of the area covered with skin grafting.
later T.anterior and EHL will be recontructed with facia lata graft.
(with the help of plastic surgeon)

 

Suresh:
Marie Williams out of Barry U. in Miami and Stephen Brigido out of East Stroudsburg, PA have reported extremely good results in cases like this using Wright's Graft Jacket.
http://wmt.dev.lunaweb.net/Literature/docs/121P0129 Rev H.pdf
(sorry, you'll have to paste this)
I've attended lectures by both and was amazed at the large defects they treat using this product.
Good luck
Steve

 

Until the surgery is completed, do you have access to products such as "Jelonet"
http://wound.smith-nephew.com/uk/Product.asp?NodeId=738
and padding. Also is you pt. on IVAB's ?

 

7 weeks follow up.

debridement and split skin graft done.
graft over Tibialis anterior taken well.but lost over EHL.

now she is walking comfortably.


but she has restriction of both ankle dorsiflexion and plantarflexion..
hypertrophy of the graft .


suresh

 

6 months followup