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#1
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06-21-2009, 04:50 AM
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 My Rank: PRIVATE Poster Rank:5551 male Join Date: Apr 2009 Posts: 44 Mentioned: 0 Post(s) Quoted: 0 Post(s)
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Accidental Discharge - 12-gauge/left Foot
History An 18-year old Caucasian male presented to the Emergency Department of our institution with a self-inflicted accidental gunshot injury to his left foot, sustained whilst reloading the weapon. This was an isolated injury, and the patient was an otherwise healthy non-smoker. The weapon involved was a 12-gauge shotgun at close range. The tract of the projectiles was from dorsal to plantar. There was an extensive area of soft tissue and bone loss medially from the mid-foot. Diagnosis Severe soft tissue injury with marked bone stock loss of the left medial foot, complete loss of the 1st and 2nd cuneiform, fracture of the navicularis and the 1st metatarsal, avulsion of the 2nd metatarsal head. Treatment The patient underwent emergency debridement and lavage of the wound, and was treated with intravenous antibiotics (amoxicillin / clavulanic acid) and tetanus immunoglobulin. He went on to have repeat lavage and debridements on days 2 and 4 post injury. On day 7 post injury he underwent a combined Orthopaedic and Plastic Surgical procedure where autologous tricortical bone graft from the ipsilateral posterior iliac crest was used to reconstruct the medial column of the foot. Bridging fixation was achieved by the use of a proximal humeral locking compression plate, with the proximal end of the plate fixed into the navicularis and the shaft of the plate fixed to the 1st metatarsal. A conventional screw was used to lag the plate across the 1st metatarsal into the 2nd metatarsal. The longitudinal fracture of the navicularis was fixed with a 3.5mm lag screw. The avulsed tibialis anterior tendon was reattached onto bone, using the small holes of the proximal portion of the plate designed for rotator cuff repair. Soft tissue coverage was then accomplished with a serratus anterior free muscle flap. This flap comprised the lower 3 digitations of the left serratus muscle and the raised thoraco-dorsal pedicle with the thoracodorsal artery and vena comitantes. The long thoracic nerve was preserved. Arteriovenous anostomosis was performed with end to end thoracodorsal artery to dorsalis pedis artery and an end to end vena comitantes for the dorsalis pedis to the thoracodorsal vein. Skin graft was harvested from the left thigh, half of this graft was used as sheet graft to cover over the muscle flap, and the remaining skin graft was meshed and secured to cover the sole defect. The patient was put in a fiberglass splint to achieve postoperative immobilization. Once the flap and wounds had healed satisfactorily, he was mobilized non-weight-bearing on the left side. -Hey Zeus Guevara-  ·  ·  ·  ·  ·  ·  ·  ·  ·  ·  ·  · |
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#2
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06-21-2009, 06:48 AM
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 My Rank: CORPORAL Poster Rank:1617 Join Date: May 2009 Posts: 340 Mentioned: 0 Post(s) Quoted: 9 Post(s)
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Re: Accidental Discharge - 12-gauge/left Foot
deformity aside, that guy needs to seriously think about feet hygiene
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