Lower Limb Salvage at any Cost - A Complex Case

Amir K Bigdeli, Frederick J Hernekamp, Florian Neubrech, Nico Leibig, Chrisitan Radu, Emre Gazyakan, Ulrich Kneser and Thomas Kremer

Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany

^*Correspondance to: Amir Khosrow Bigdeli 

 PDF  Full Text DOI: 10.25107/2474-1647.1380

Abstract

Lower limb salvage for osteomyelitis of the tibia after open fracture presents an ongoing challenge. In the field of modern reconstructive surgery, we increasingly find ourselves asking “What can we salvage?” instead of “What should we salvage?” We report the case of a 37-year-old male patient, who sustained an open tibial fracture in a motorcycle accident. He underwent more than thirty operative procedures for lower limb reconstruction over a five-year period. Complicated by osteomyelitis, limb salvage was finally achieved with a free contralateral vascularized osteocutaneus fibular transfer after 13-hour surgery. The combination with an arterio-venous loop was necessary for and created through the cephalic and small saphenous vein as unusual feature due to sacrifice of autologous vein grafts for previous reconstructive procedures. Two years later, the patient is satisfied with his limb function and has returned to work. The free osteocutaneous vascularized fibula transfer prevented lower limb amputation but still remains complex and invasive. We want to discuss aspects of decision-making involving clinicians as well as the patient and recommend the installation of multidisciplinary extremity boards.

Keywords

Free fibula; Distal tibia fracture; Limb salvage; Arteriovenous loop

Cite the article

Bigdeli AK, Hernekamp FJ, Neubrech F, Leibig N, Radu C, Gazyakan E, et al. Lower Limb Salvage at any Cost - A Complex Case. Clin Surg. 2017; 2: 1380.