Deshraj and Bus

Deshraj was a factory worker in Gurgaon. He belonged to a near by village situated in district of rewari. He was a ITI pass out who come to gurgaon in search of job 20 years back. Working in factory he has steadily progressed from worker to supervisor . His children were grown up and they settled in and near gurgaon. His wife use to stay with his parents in village,he use to come to his village in off time and weekends.
 It was a hot summer day in month of may 2017, he was boarding a bus for Gurgaon on a near by highway to jaipur from delhi. He was talking to his wife while climbing on bus , bus driver in perpetual hurry released clutch to march bus. Deshraj foot slipped from foot board it was run over from left front wheel of bus. He was taken to a near by hospital , his family took him to ESI hospital Guurgaon. Given conditions and attitude in government hospital, his family decided to take refuge in private healthcare. His family chose FMRI Gurgaon , he was admitted under care of Dr Balwinder Rana . Dr Balwinder was a orthopedic surgeon who specialize in trauma and foot surgery. Dr Balwinder  decided to debride the wound ,place external fixator for fracture lower end tibia. Next day VAC dressing was planned for the foot, I was informed and planning for cover was done. VAC is brilliant new thing in wound care it seals wound , reduces edema, infection and promotes granulation.
I met patient and family and told my plan , answered their questions . They were reasonable people , we placed a request with insurance for approval of surgical plan. Approval come and he was planned for surgery on 1/6/2017.

finally saved foot year is 17 not 15

On 1st june I along with Dr Anil Behl operated him , we opened vac dressing. We dissected posterior tibial vessel's and harvested lattismuss dorsi muscle . After insetting muscle we anastomose flap artery end to side to post tibial artery and connected flap vein to vena comitants . It went off well and patient was kept in ICU for flap monitoring.flap was placed on volar side to reconstruct sole, and dorsal foot was skin grafted. It is standard reconstructive plan for foot it works well.On post operative day 3 he shifted to ward and discharged after seven days of surgery. He come for dressing at regular interval. These big reconstructions are not with out their share of problems, he had great toe phalanx which exposed and necrosed. Dead bone needs removal and due to apprehension of pain Dr Behl proposed to remove it in operation theater . Indians are by nature frugal people , cost of surgery made him and his son apprehensive and they called me. I assured him that we will do it in local anesthesia, and we did it . Wound healed but small area remain of postage stamp size. It was decided to expedite ORIF of lower tibial fracture and skin graft the ares in single sitting.
Slowly fracture united grafts taken up, wounds healed foot made tiny steps towards recovery. At last all his wound healed as shown in above photo.