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KMID : 0978920220230010067
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Korean Journal of Clinical Geriatrics
2022 Volume.23 No. 1 p.67 ~ p.71
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Salvage of Both Lower Limbs with Multiple Crushing Injuries in an Octogenarian
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Jeon Hong-Bae
Kim Hyon-Surk
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Abstract
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Salvage and reconstruction of crushed lower extremities is a complicated and difficult process, even more so in geriatric patients.
An 82-year-old female on hypertension and diabetes medication including anticoagulants with normal pre-injury functional status was admitted for extensive crushing injuries to both lower limbs inflicted by a truck. After orthopedic initial management of multiple open fractures, the patient was referred for wound coverage of the mangled extremities. Though extensive injuries to the joints compounded with her advanced age forecasted poor functional prognosis, limb salvage was attempted to avoid amputation and its consequences. Employing serial debridement and negative pressure wound therapy, the exposed right proximal tibia was covered with a lateral gastrocnemius and hemisoleus flap, and the left ankle open fracture was covered with a delayed reverse sural flap. Skin defects and necrotic areas were ultimately reconstructed with skin grafts. A new right ankle wound caused by a neglected fracture was covered with an anterolateral thigh free flap after fracture fixation. Establishing a proper reconstructive strategy with reliable aspects can enable successful salvage of what initially appeared to be almost hopelessly mangled lower extremities, even in geriatric patients over 80 years of age.
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KEYWORD
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Crush injuries, Limb salvage, Octogenarian
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