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Lower extremity trauma may result in loss of skin and/or muscle and expose critical structures such as bone, tendon or blood vessels. These structures require soft tissue coverage to prevent infection and further complications. Sometimes following surgical stabilization of bones, the implant(s) may become exposed and this situation similarly requires soft tissue coverage to prevent infection of the implant, bone and surrounding tissue. Expedient wound management minimizes many downstream complications and your best care is found in private hospitals, where ample facilities and resources are available to facilitate this.
Lower extremity trauma often presents in the acute setting at the Emergency Department where the wounds are noted in conjunction with the bony fractures. The skin and muscles may be lost due to the accident and resulting in exposed critical structures. Less commonly, the blood vessels of the extremity may also be lost at the time of the accident, resulting in absent blood supply to the downstream (distal) portion of the extremity.
Lower extremity trauma wounds may also occur as a result of wound infection following fracture fixation. The wounds may be non-healing, resulting in exposed implant(s). These require tissue coverage to prevent bacterial colonization of the implant, and extension of infection into the fracture site.
The timing of reconstruction is dependent on the nature of the injury. The timing of reconstruction may include:
Lower extremity reconstruction is performed together with a partnering orthopedic surgeon. Wound debridement (removal of infected and nonviable tissue) and bony stabilization is performed. There may an occasional need to perform investigations to ascertain the health of the blood vessels supplying the extremity such as angiography or Duplex ultrasonography. Successful reconstruction outcomes are often possible after the infection has been cleared from the wound. Depending on the anatomical location of the defect, size and depth, a variety of skin grafts, regional or distant flaps may be performed for its coverage.
Most individuals will require a short hospital stay following the surgery. Weightbearing of the injured extremity is dependent on the stability of the fracture and its fixation, and postoperative physical therapy and rehabilitation. Stitch removal is performed at around the 21st postoperative day.
Smokers are advised to for cessation of smoking for at least 3 weeks postoperatively to minimize the possibility of complications relating to delayed wound healing. Skin grafts and flaps placed over mobile areas such as joints will require a short period of immobilization until they are fully healed.
The lower extremity has locomotive, psychological and aesthetic functions. Extremity preservation is of significant importance and successful reconstruction is a keystone in its salvage. Dr Yeo is experienced in the field extremity preservation. He completed a fellowship in Advanced Microsurgical Reconstruction under Professor Hung-Chi Chen, one of the international pioneers and leaders in extremity salvage. He has since performed many successful cases of extremity salvage in Singapore since completion of his fellowship.