PMC3134705_01
Initial postoperative presentation of the patient; skin necrosis surrounded by areas of erythema is noted.
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F1
When seen for consultation by the plastic surgery service, the patient had developed significant additional skin necrosis and erythema (Figure 1), though the patient was still afebrile without leucocytosis.
Wound presentation after initial radical debridement of necrotic and infected tissues.
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F2
The specimen consisted of multiple fragments of necrotic tissue, with foci of necrosis, showing connective tissue with extensive necrosis and necro-inflammatory debris, as well as acute osteomyelitis affecting the small bone fragments (Figure 2).
Wound presentation after second debridement done 2 days after the initial debridement.
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F3
A second debridement was done 2 days later, creating an open wound composed of most of the medial aspect of the right leg surface, after which the patient was begun on a 2-week course of intravenous antibiotics followed by a 10-day course of oral antibiotics, and the patient was discharged home on hospital day 14 (Figure 3).
Healthy granulation tissue throughout the wound seen after 3 weeks of repeated dressings and wound care.
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F4
When adequate granulation tissue was achieved, the wound was once again debrided (Figure 4), and the entire defect was covered with a split-thickness skin graft (Figure 5).
Postoperative view of meshed split thickness graft used to cover the wound surface.
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F5
When adequate granulation tissue was achieved, the wound was once again debrided (Figure 4), and the entire defect was covered with a split-thickness skin graft (Figure 5).
Final wound outcome after complete take of the graft with full epithelialization of the skin.
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F6
The skin graft continued to heal until the wound was covered (Figure 6).