PMC5784384_01
Left upper extremity upon arrival to Canada. Left upper extremity status upon arrival to Canada prior to undergoing first Canadian operative management demonstrating Volkmann's contracture.
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The wrist and digits were flexed demonstrating signs of a significant Volkmann's contracture (Fig. 1).
Left thigh upon arrival to Canada. Left thigh upon arrival to Canada prior to undergoing first Canadian operative management illustrating a necrotic composite graft.
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The left lower extremity wound was covered with a bolster dressing under which the necrotic composite graft was present (Fig. 2).
Left upper extremity during the initial debridement. A first urgent Canadian irrigation and debridement of the patient's left upper extremity was undertaken at the time of arrival to our institution to assess the extent of the injuries.
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Numerous significant injuries were seen (Figs. 3, 4) and are described in detail in Table 1.
Left thigh during the initial debridement. During the initial urgent Canadian irrigation and debridement, the left thigh was also debrided and assessed for the extent of injuries.
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Numerous significant injuries were seen (Figs. 3, 4) and are described in detail in Table 1.
Anterolateral thigh flap's (ALT) congested appearance. The left thigh was reconstructed using a contralateral ALT flap. The status of the flap was stable until postoperative day 6 (PID#15) when, as illustrated, the flap started to appear dusky, cold and had weakened Doppler signals.
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The postoperative course remained unremarkable up until postoperative day 6 (PID#15) when the flap appeared dusky and cold (Fig. 5) and had a weakening of Doppler signals.
Left thigh aesthetic appearance at discharge. The patient's left thigh had a good functional outcome upon discharge (PID#54) to a rehabilitation center but the aesthetic result was unsatisfactory with split-thickness skin graft coverage.
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Despite adequate functional recovery, the aesthetic result remained unacceptable (Fig. 6) and as a result, on PID#393, a final reconstructive procedure was performed to replace the split-thickness skin graft with a free transverse rectus abdominus myocutaneous flap (TRAM).
Left thigh second reconstructive attempt. The left thigh was reconstructed with a transverse rectus abdominus myocutaneous flap and the aesthetic outcome was satisfactory as shown on postoperative day 28.
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An acceptable aesthetic and functional outcome was achieved (Fig. 7).
Left thigh postoperative final appearance. The left thigh free transverse rectus abdominus myocutaneous flap's final appearance 28 days after its inset and 421 days post injury.
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