Salvage of Upper Limb following a Severe Crushing Trauma: Immediate Reconstruction with a Free Flap and Subsequent Hyperbaric Oxygen Therapy

Abstract

A microsurgical latissimus dorsi flap was performed for resurfacing a large soft tissue defect of the forearm with exposure of the vital structures and contaminated wound. Early coverage of a defect is a generally accepted concept to achieve a better functional result. The authors present a case report where a free latissimus dorsi flap with subsequent hyperbaric oxygen therapy allowed a successful single stage reconstruction of this complex severely contaminated defect.

Figure 1

Preoperative crush injury right forearm.

Figure 2

Intraoperative external and intramedullary fixations.

Figure 3

LD flap with anastomosis of the vessels.

Figure 4

Postoperative at 2 weeks.

Figure 5

Postoperative at 2 weeks.

Figure 6

X-ray showing a further displacement of the fracture fragment of the radius, with ulnar deviation of the wrist.

Figure 7

X-ray showing a reduced fracture with plates and screws.

Figure 8

Followup at 1 year with 95% recovery of the flexor tendons.

Figure 9

Followup at 1 year with 40% recovery of the extensor tendons.

Figure 10

Patient able to write.

Figure 11

Patient able to carry a glass.

Figure 12

Patient showing a good strength.