PMC6358379_01
(A) Intraoperative view of the abdominal wall, the gluteal region, and the leg. (B) Admission pelvic anteroposterior X-ray showing the dislocation of the left sacroiliac joint, diastasis of the pubic symphysis. (C) Intraoperative view of a following Ilizarov application and wound management. (D) View of new granulation generated on the surface of the peritoneum in the 3rd debridement.
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F1
Meanwhile, anus and the perineum were torn (Fig. 1A). X-ray imaging showed left sacroiliac joint dislocation and pubic symphysis diastasis (Fig. 1B). Pelvis was stabilized with an external fixator (Fig. 1C). By the third debridement, new granulation tissue was generated on the evident on the surface of the peritoneum (Fig. 1D).
(A and B) View of the combination of devices: the RNPT, Ilizarov, and TopClosure for wound management.
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F2
Thus a TopClosure device, along with a RNPT assisted Ilizarov device were utilized to aid with wound approximation (Fig. 2).
(A and B) Skin defects in the anterior and posterior thigh and perineum before the 4th operation. (C and D) Skin defects decreased to 14 x 9 cm by 9th operation. (E and F) Skin grafted during the 17th operation.
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F3
Ilizarov device was discontinued as skin coverage had progressed enough to allow direct application of the TopClosure devices (Fig. 3C and D). At the 17th operation, after the wound had decreased 85% in size, skin grafts were performed (Fig. 3E and F).
Six months after hospital discharge: (A) patient standing with her prosthesis; (B and C) X-ray films demonstrating scoliosis and subluxation of the right hip.
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F4
Six months after hospital discharge, the patient is able to ambulate with a single limb and a prosthesis (Fig. 4A). She has developed a compensatory scoliosis and subluxation of the right hip, which are being followed clinically (Fig. 4B and C).