PMC6704381_01
A) Posterior view of the left upper extremity after initial debridement and external fixation. Notice the extensive loss of bone and muscular tissue from the upper arm. B) Post operatory anterior posterior X ray of the left upper extremity displaying bone grafts fixated with a metal plate to the remaining bone tissues of the arm. C) Early post operatory image showing a functional extremity with an integrated DF.
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During this initial procedure extensive irrigation and debridement of nonviable tissue were performed, followed by external fixation of the humerus, aiming for a definitive reconstructive procedure during a second intervention (Fig. 1A). During the reconstruction, bilateral peroneal grafts were harvested to reconstruct the damaged bone, and were fixated with a titanium metal plate to the proximal and distal humeral remnants in the upper arm (Fig. 1B). Also, an ipsilateral dorsoepigastric pediculated flap, with a cutaneous island of 18 x 7 cm was designed and utilized for coverage of the defect (Figs. 1C, 2 and 3).
Picture showing the patient in lateral decubitus during primary reconstruction. Peroneal grafts are being used to reconstruct the damaged humerus while being fixated to surrounding viable bone tissue.
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Also, an ipsilateral dorsoepigastric pediculated flap, with a cutaneous island of 18 x 7 cm was designed and utilized for coverage of the defect (Figs. 1C, 2 and 3).
Picture showing the patient in lateral decubitus during primary reconstruction. DF is already dissected and ready to be fixated in the left upper extremity after extensive cleaning and debridement.
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Also, an ipsilateral dorsoepigastric pediculated flap, with a cutaneous island of 18 x 7 cm was designed and utilized for coverage of the defect (Figs. 1C, 2 and 3).
A) X ray taken after total shoulder prosthetic replacement 3 years after the initial procedure. B & C) Pictures taken during patients follow up showing functional and aesthetically acceptable results in his left upper extremity at follow up.
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Sensibility remains partially compromised, with intermittent disesthesias over the area covered by the flap, but there are no signs of atrophic changes over the arm and forearm muscles (Fig. 4).