Massive Soft Tissue Lesion

[SavageGlow]

56-year-old man with a massive soft tissue lesion at the lateral side of the left femur and tibia was transferred to the Accident and Emergency Department (AED) after a road traffic accident. The patient was resuscitated according to the Advanced Trauma Life Support (ATLS) protocol. After stabilization of his vital signs, an imaging study was performed. X-rays and computed tomography (CT) scan revealed a fracture of the lateral femoral condyle and a comminuted fracture of the proximal third of the left tibia (Gustilo-Anderson type IIIB). These fractures were associated with extended soft tissue damage (wound defect size 37 cm x 15 cm, 555 cm²) at the lateral side of the left femur and tibia (Figures 1A, 1B). A cast was placed for provisional stabilization. The primary and secondary survey did not reveal any other major injury except mild concussion and peri-traumatic amnesia.

>>The patient was taken to the theatre. Debridement and exploration of the wound were performed. The fracture was reduced and immobilized using an external fixation device (Hoffmann® II External Fixation System Stryker®). Forty-eight hours post-injury, the patient was taken back to the theatre. Debridement of the wound and a negative pressure wound therapy system (NPWTS) was applied (pressure applied on 125mmHg - Simex 300 ®). The NPWTS was replaced every four days (Figures 2A, 2B). On day 33, the patient was taken to the theatre for a final review and an autologous skin graft was used to cover the skin defect (Figure 3). The skin graft was harvested by the anterior aspect of the femur. The patient was discharged on day 40 and was followed up on a regular basis at the outpatients' department.

[Mr.NoCredit]

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