Surgical bone deformation in treatment of soft tissue wounds and gunshot tibia defect: A Case Report-Reference-Cited by-同舟云学术

Surgical bone deformation in treatment of soft tissue wounds and gunshot tibia defect: A Case Report

Published:2024-08-29 Issue: Volume: Page:
ISSN:2542-0933
Container-title:Traumatology and Orthopedics of Russia
language:
Short-container-title:Traumatology and Orthopedics of Russia

Author:

Khominets Vladimir^ORCID,Mikhailov Sergey^ORCID,Shchukin Alexey^ORCID,Nagornyi Evgenii^ORCID,Zhumagaziev Sayan^ORCID,Tsoy Danil^ORCID

Abstract

Background. The problem of treating wounded patients with defects in soft tissues and bones of the extremities continues to remain relevant. One of the ways to close soft tissue defects, especially with loss of bone tissue, with open fractures of the bones of the extremities, is acute shortening and the creation of artificial angular deformation of the segment. The aim of the study – show the possibility of using the technique of acute shortening and angulation of the segment to replace soft tissue and bone defects in the treatment of a patient with a gunshot wound to the leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in the soft tissues and bones of the lower leg in the middle third. In order to reduce the size of the wound, acute shortening and angulation of the leg was performed. The intentional angular deformation of the tibia was 24º, shortening up to 8 cm. The next stage, after closing the residual soft tissue wound defect with local tissues and split skin autograft, was fixation of the tibia with an Ilizarov hinge-distraction apparatus, followed by gradual correction of the angular deformity. At the next stage - osteotomy of the tibia to eliminate shortening using the Ilizarov method (distraction rate 1 mm per day). After restoring the length of the tibia, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from the displaced fragment. At a follow-up examination after 14 months. after injury, the patient walks with full weight bearing on the injured limb without additional means of support, and continues to perform military service duties in accordance with his position. Conclusions. The clinical case we presented demonstrates that acute shortening of a limb segment with the formation of an artificial angular deformity is a safe and effective method for temporarily closing a gunshot defect in soft tissues.

Publisher

ECO-Vector LLC

Link

https://journal.rniito.org/jour/article/viewFile/17532/pdf

Reference26 articles.

1. Хоминец В.В., Шаповалов В.М., Михайлов С.В., Брижань Л.К. Cовершенствование лечебно-эвакуационных мероприятий в современных локальных войнах. В моногр.: Лечение раненных в конечности в войнах и вооруженных конфликтах / В. Хоминец, В. Шаповалов, С. Михайлов, Л. Брижань. – Санкт-Петербург: Историческая иллюстрация, 2021. с. 40–64. [Khominets V.V., Shapovalov V.M., Mikhailov S.V., Brizhan L.K. Improving medical and evacuation measures in modern local wars. In: Treatment of wounded limbs in wars and armed conflicts. / V. Khominets, V. Shapovalov, S. Mikhailov, L. Brizhan. – Санкт-Петербург: Историческая иллюстрация, 2021. p. 40–64. In Russian].

2. Grubor P., Falzarano G., Medici A. et al. The Damage Control Orthopedics and External Fixation in traffic accident after 20 Years in the Bosnian War: Our Experience and a Review of the Literature. SYLWAN. 2014;158(6):90-109.

3. Волгас Д.А., Хардер И. Методы хирургического шва и укрытия ран. В кн.: Мягкие ткани в травматологии. Принципы обращения и клинические случаи. Волгас Д.А., Хардер И. Берлин, Васса-медиа, 2016. с. 126-201. [Volgas D.A., Kharder I. Methods of surgical suture and wound coverage. In: Soft tissues in traumatology. Treatment principles and clinical cases. Volgas D.A., Kharder I. Berlin, Vassa-media, 2016. p. 126-201. In Russ].

4. Liu H., Liu J., Wu Y. et al. Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs. Orthop Surg. 2023;15(6):1534-1540. https://doi.org:10.1111/os.13727.

5. Крюков ЕВ., Давыдов Д.В., Хоминец В.В. [и др.] Этапное лечение раненых с повреждениями опорно-двигательной системы в современном вооруженном конфликте. Военно-медицинский журнал. 2023;344(3):4-17. [Kryukov E.V., Davydov D.V., Khominets V.V. et al. Staged treatment of the wounded with injuries of the musculoskeletal systems in modern armed conflict. Military medical journal. 2023;344(3):4-17. In Russian].