Artificial deformity creation in treatment of soft tissue wounds and lower leg bones defect: a case report
- 作者: Khominets V.V.1, Mikhailov S.V.1, Shchukin A.V.1, Nagornyi E.B.1, Zhumagaziev S.E.1, Tsoy D.R.1
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隶属关系:
- Kirov Military Medical Academy
- 期: 卷 30, 编号 3 (2024)
- 页面: 85-94
- 栏目: Case Reports
- URL: https://ogarev-online.ru/2311-2905/article/view/268331
- DOI: https://doi.org/10.17816/2311-2905-17532
- ID: 268331
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详细
Background. The problem of treating wounded patients with defects of soft tissues and bones of the extremities continues to be relevant. One of the ways to close soft tissue defects, especially in case of bone tissue loss, after open fractures of the extremities is acute shortening and creation of artificial angular deformity of the segment.
The aim of the study — to demonstrate the possibilities of acute shortening and angulation of the segment as a technique to replace soft tissue and bone defects in treatment of a patient with a gunshot wound to the lower leg.
Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in soft tissues and bones of the lower leg in the middle third. To reduce the wound size, acute shortening and angulation of the lower leg was performed. The intentional angular deformation was 24º, shortening — up to 8 cm. The residual soft tissue wound defect was closed with local tissues and split skin autograft. The tibia was fixed by the Ilizarov hinge-distraction apparatus with following gradual correction of the angular deformity. After that, one performed osteotomy of the tibia in order to eliminate shortening with the Ilizarov method (the distraction rate of 1 mm per day). After restoring the length of the lower leg, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from a displaced fragment. At a follow-up examination, in 18 months after the injury the patient walks with full weight bearing on the injured limb without any additional means of support, continues to perform military service duties in accordance with his position.
Conclusions. The presented clinical case demonstrates that acute shortening of a limb segment with creation of artificial angular deformity is an effective method for temporary closure of a gunshot defect of soft tissues. The technique allowed closing critical soft tissue defect of the lower leg and restoring the anatomy (length) of the segment. Consequently, one was able to achieve satisfactory treatment results and restore the functions of an injured limb. Besides, acute temporary shortening technique eliminated the need to perform technically sophisticated and lengthy microsurgical reconstructions, which are associated with a flap replacement for closure of soft tissue defects in a shotgun fracture area.
作者简介
Vladimir Khominets
Kirov Military Medical Academy
Email: khominets_62@mail.ru
ORCID iD: 0000-0001-9391-3316
SPIN 代码: 5174-4433
Dr. Sci. (Med.), Professor
俄罗斯联邦, St. PetersburgSergey Mikhailov
Kirov Military Medical Academy
Email: msv06@mail.ru
ORCID iD: 0000-0002-3738-0639
SPIN 代码: 2086-1862
Cand. Sci. (Med.)
俄罗斯联邦, St. PetersburgAlexey Shchukin
Kirov Military Medical Academy
Email: ossa.76@mail.ru
ORCID iD: 0000-0001-7754-8478
SPIN 代码: 9717-5714
Cand. Sci. (Med.)
俄罗斯联邦, St. PetersburgEvgenii Nagornyi
Kirov Military Medical Academy
Email: 9099744@gmail.com
ORCID iD: 0000-0003-2132-4429
SPIN 代码: 8732-8180
Cand. Sci. (Med.)
库克群岛, St. PetersburgSayan Zhumagaziev
Kirov Military Medical Academy
编辑信件的主要联系方式.
Email: shumagasiev@mail.ru
ORCID iD: 0000-0002-5169-2022
SPIN 代码: 1226-5639
Cand. Sci. (Med.)
俄罗斯联邦, St. PetersburgDanil Tsoy
Kirov Military Medical Academy
Email: tsoydanil@mail.ru
ORCID iD: 0009-0007-3354-4644
俄罗斯联邦, St. Petersburg
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