brahmanand clinic

EXPOSED BONE  Wound excision PERFORATOR INDENTIFIED Flap insetted Donor site skin grafted 21  year old young man met with a accident . He suffered severe head injuries ,abdominal injuries and  fracture leg . He was treated conservatively for head injuries and splenic injuries . Leg fracture was with a small wound. It was debrided and VAC therapy was applied for one week . After one week patient was taken up for ORIF and nailing was done. And wound was covered with a VAC After one week patient was planned for flap cover as the wound was bigger. Decision to do gastrocnemius was taken , doppler was done to identify perforator for skin paddle. Skin paddle was marked and elevated along with a muscle and transferred. Flap was insetted and donor site was skin grafted . Dr Adhishwar Sharma MBBS,MS Gen Surgery PGIMER Chd Mch Plastic Surgery Fellowship in Hand and Microvascular Surgery brachialplexus7.blogspot.com brahmanandclinic.com 8860650846

pre op wound after deridement gracillis muscle with pedicle muscle being insetted post op day 10 healthy muscle and graft taken up 42 year old iraqi male suffered electric contact burn ,which resulted in loss of skin ,tendons and exposed bone.. Wound was debrided and VAC was applied and culture was done . Antibiotics according to culture were given. After 10 days of VAC therapy decision to operate was taken. Bone was nibbled and gracillis flap was taken to cover it. Flap artery was connected end to side to anterior tibial artery and vein was connected end to end to venae comitantes. Patient was anticoagulated for 5 days and flap monitoring was done. After six days of surgery patient was discharged and put on ecosprin for one month. Regular dressing were done and flap epithelized rapidly . Microvascular surgery is difficult in high voltage electric burn injuries as in these case . Electric current travels through neurovascular bundles. Dead bone is a good