Cases (I)



10.1055/b-0034-84285

Cases (I)



12 Cases



12.1 Introduction


Authors David A Volgas, Yves Harder


In addition to knowing how to perform reconstructive surgery on bone and soft tissues, the surgeon must develop an understanding of when and why to choose a particular option. In most cases, there are many feasible options and only few choices that are absolutely right or wrong. But in any given situation, there may be a solution that is most appropriate.


The following twenty cases depict frequent or exemplary soft-tissue problems of the extremities encountered by the orthopaedic trauma surgeon. However, it should be noted that not all cases require the same level of skills and not all procedures described can be performed by a trauma surgeon. Cases presented in the following section are grouped according to various skill levels. The degree of difficulty in performing the featured surgical procedures increases along with the skill level. Skill level I represents what a general orthopaedic surgeon could perform. Skill level II would be feasible for a trauma surgeon. Skill level III requires a surgeon with some training in soft-tissue coverage, whereas skill level IV requires a surgeon trained in microvascular surgical procedures. The level of required surgical skill is indicated in the table below and in each case.


The focus of these case presentations is on the surgeon′s train of thought and decision-making process rather than on surgical techniques. By following the experienced surgeon′s thoughts, the reader will learn to understand:




  • the process of identifying and selecting feasible options for a certain patient



  • the difference between feasible and best options



  • when to refer a case to—or ask advice from—a surgeon trained in more advanced reconstructive techniques.

































































































































































































































Tab. 15.1

Case number


Skill level


Case type


Location


Indication


Vascular pattern


Type of transfer


Tissue composition


Page


12.1


I


Fracture blisters


Distal tibia


Closed fractue





234


12.2


I


Debridement


Arm


Open fracture





237


12.3


I


Elastic vessel loops


Distal tibia


Open fracture





241


12.4


I


Negative-pressure wound therapy


Distal tibia


Open fracture





243


12.5


I


Split-thickness skin graft


Lower leg


Morel-Lavallée lesion





247


12.6


II


Transposition flap


Distal tibia


Wound dehiscence


Random


Transposition


Fasciocutaneous


250


12.7


II


Bipedicled transposition flap


Distal tibia


Open fracture


Random


Transposition


Fasciocutaneous


256


12.8


II


V-Y advancement flap


Finger


Open fracture


Random


Advancement


Fasciocutaneous


260


12.9


II


Gastrocnemius flap (medial head)


Medial knee


Wound dehiscence


Axial


Transposition


Muscle


264


12.10


II


Gastrocnemius flap (medial head)


Medial knee


Open fracture


Axial


Transposition


Muscle


267


12.11


II


Soleus flap


Anterior leg


Open fracture


Axial


Transposition


Muscle


271


12.12


III


Radial forearm flap


Hand


Open fracture


Axial


Transposition


Fasciocutaneous


275


12.13


III


Distally based sural flap


Medial ankle


Traumatic defect


Axial


Transposition


Fasciocutaneous


279


12.14


III


Medial plantar flap (instep flap)


Plantar heel


Heel ulcer


Axial


Transposition


Fasciocutaneous


283


12.15


III


Free-style perforator flap (propeller flap)


Achilles tendon


Open fracture


Axial



Fasciocutaneous


287


12.16


III


Rotation flap


Sacrum


Chronic ulcer


Axial


Rotation


Fasciocutaneous


291


12.17


IV


Lateral arm flap


Lower leg


Open fracture


Axial


Free


Fasciocutaneous


294


12.18


IV


Anterolateral thigh flap


Lower leg


Open fracture


Axial


Free


Fasciocutaneous


299


12.19


IV


Latissimus dorsi/serratus anterior flap (chimeric flap)


Lower leg


Open fracture


Axial


Free


Muscle


302


12.20


IV


Fibula flap


Forearm


Open fracture


Axial


Free


Osteoseptocutaneous


307

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Jul 6, 2020 | Posted by in ORTHOPEDIC | Comments Off on Cases (I)

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