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#1
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07-05-2014, 07:28 PM
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 ✖ The Antique Christ ✖ Poster Rank:105 Gonzo Punk Join Date: Jan 2009 Posts: 15,488
Contributions: 58
Mentioned: 23 Post(s) Quoted: 2046 Post(s)
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Rotting Arm - Cellulitis
A middle aged gentleman presented with active cellulitis of the right upper limb associated with post infective soft tissue loss causing a completely exposed upper end radius with establised chronic osteomyelitis radius upper 1/3rd. He was managed by surgical debridement, antibiotic and antifungal coverage. followed by negative pressure wound therapy. There was a lot of thought process for the flap coverage as: 1.All local flaps looked impossibe due to active cellulitis exteding from arm to the wrist 1.Brachioradialis was found to be fibrotic intra operatively 2.Radial forearm flap was out of question 1.As patient requried later reconstruction in form of tendon trasnfers 2.Already poor function of the right hand will be further compromised with skin grafting of the upper extremity 2.Free flap options were limited and due to presence of active cellulitsis - Options looked poor though it was kept as an option 1.ALT flap and Gracilis flap were kept in mind with possible problems during harvest and later mobility with bilateral above knee stumps 2.TAP flap was also kept as an option. 3.There was also a thought about late reconstruction for hand function with 1.Median nerve palsy 1.Ape thumb deformity 2.Radial nerve palsy. 1.wrist drop 2.finger drop We were prepared on table for a free flap but took our chances with the distal extension of Lateral arm flap as a transposition flap cover and it worked fine - Doppler picked active signals showing axial vascularity for the flap. This was followed by flap coverage and skin grafting. Pictures are shown below.  PRESENTING PICTURE - CHRONIC OSTEOMYELITIS WITH ACTIVE CELLULITIS AND ABSCESS FORMATION  PRESENTING PICTURE - CHRONIC OSTEOMYELITIS WITH ACTIVE CELLULITIS AND ABSCESS FORMATION  CLOSE UP PICTURE - CHRONIC OSTEOMYELITIS WITH ACTIVE CELLULITIS AND ABSCESS FORMATION  PICTURE SHOWING BILATERAL ABOVE KNEE AMPUTATION IN THE SAME PATIENT  AFTER SURGICAL DEBRIDEMENT AND NEGATIVE PRESSURE WOUND THERAPY  AFTER SURGICAL DEBRIDEMENT AND NEGATIVE PRESSURE WOUND THERAPY  PICTURE BEFORE FLAP COVERAGE AND SKIN GRAFTING  CLOSE UP PICTURE BEFORE FLAP COVERAGE AND SKIN GRAFTING  PICTURE SHOWING PRESENCE OF CUBITAL SOFT TISSUE LOSS  PICTURE SHOWING PRESENCE OF SKIN LOSS IN THE VOLAR ASPECT OF WRIST  AFTER TRANSPOSITION FLAP (lateral arm flap extension area )COVERAGE AND SKIN GRAFTING - PRIOR TO DISCHARGE  AFTER FLAP COVERAGE AND SKIN GRAFTING - PRIOR TO DISCHARGE |
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#2
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07-05-2014, 07:41 PM
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 My Rank: FIRST SERGEANT Poster Rank:436 Comrade Join Date: Aug 2013 Posts: 2,635 Mentioned: 14 Post(s) Quoted: 1167 Post(s)
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Re: Rotting Arm - Cellulitis
What's eating him?!  |
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#8
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07-07-2014, 12:42 AM
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| My Rank: PRIVATE Poster Rank:9157 Join Date: Feb 2010 Posts: 17 Mentioned: 0 Post(s) Quoted: 3 Post(s)
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Re: Rotting Arm - Cellulitis
Hard to say. Most commonly Staph. Aureus is the culprit in osteomyelitis. However, if he had under lying medical conditions could be a different bug. Nothing is certain until you culture the wound. Bad stuff though indeed..
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