Leg gracillis mustafa Zaiden

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Mustafa Zaiden was a college student in Iraq in year 2016 , once while going to college he met with a accident involving road side bomb blast. He's initial treatment was in Iraq, he underwent laparotomy and ileostomy for abdominal injury.External fixator was applied for femur. Foot injury   refused to heal it gradually developing into a osteomyletic wound  for which amputation was advised. Femur was refusing to unite and doctors treating were not giving any hope.

 In desperation they looked out side and contacted many people in India, in February they landed in India .Patient was bed ridden because of foot wound ,external fixator on the thigh. After seeing patient I decided to debride the foot wound and apply VAC. I also took opinion of orthopedic surgeon about thigh wound ,they advised to excise the wound and put a flap and may then they will remove external fixator. Patient had a ileostomy and it was decided to contact  Dr AK Kriplani head MABGIS team for the same. Patient under went assessment for suitability of ileostomy closure.On 8/2/17 we did the debridement and  next day applied VAC and a week after this ileostomy closure was done. Ileostomy closure went of well and patient was discharged after ten days. Now patient sent to ortho for review and some how landed in another hospital where his external fixator was removed .

This was done in march 2017  and patient in hope of cheaper options took multiple consultations but none fructified.Doing free flaps on lateral aspect of knee is not a easy task,
On 28/4/2017 I planned surgery and plan was to do saphenous vein graft AV fistula ,tendoachillies release and gracillis free flap tall order by any standards . I requested Dr Rahul kapoor a young microvascular surgeon to help me . We started it went of fine and long list of surgeries took lot of time to finish.We started with dissecting saphenous vein from ankle to saphenofemoral junction and attached vein to femoral artery.
Then we did tendo achilles lengthening at muscle and tendon junction. After this same side gracillis was harvested and transferred to wound and AVF vessel were brought  after making space. AVF was divided and arterial end was connected to flap artery and venous end was connected to flap vein under microscope.                                                                                                                                

 Post operative largely uneventful and patient was discharged at post op day 7 .After one month he returned to Iraq and after three months he send me this video.                                                                                                               
                                                                                               






Lateral knee wound and foot deformity

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Dr Adhishwar Sharma +91 8860650846

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