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Severely damaged lower limb salvage in a critically ill burned patient. Lessons learned

Authors
  • Aguilera-Saez, Jorge
  • Lopez-Masramon, Bernat
  • Collado, Jose M
  • Monte-Soldado, Alejandra
  • Rivas-Nicolls, Danilo
  • Serracanta, Jordi
  • Barret, Juan P
Type
Published Article
Journal
International Journal of Burns and Trauma
Publisher
e-Century Publishing Corporation
Publication Date
Oct 15, 2020
Volume
10
Issue
5
Pages
191–200
Identifiers
PMID: 33224606
PMCID: PMC7675203
Source
PubMed Central
Keywords
Disciplines
  • Original Article
License
Unknown

Abstract

Lower limb salvage in severely injured burned patients with bone or tendon exposure may be a reconstructive challenge. In this cases, local or regional flaps and other more conservative therapies such as dermal substitutes and negative-pressure wound therapy are usually not available or are not good enough to solve the problem. In such situations, microsurgical reconstruction with distant flaps seems to be the best option, even though the particularities of the severe burn patient may decrease free flaps’ success rate. We report the case of a patient with severe electrical injuries affecting 70% of the total body surface area who had full-thickness burns to the lower extremity with wide bone exposure and extensively drug-resistant Pseudomonas aeruginosa infection. We achieved limb salvation using rectus femoris muscle free flap plus lateral and medial gastrocnemius muscle flaps and soleus muscle flap, after two failed microsurgical coverture attempts and a long not useful periplus with conservative therapies such us negative-pressure wound therapy and dermal substitutes. After 3 years of follow-up, the patient can walk without aid, and he has recovered his social and employment situation prior to the accident.

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