PMC10152960_01
Avulsion injury of the nasal bones and nasal septum from glabella in the anterior 1/3 continuing with an inferiorly based flap to upper lips and both the cheeks, the cartilaginous septum was separated from the white perpendicular plate of the ethmoid, the left medial canthus ligament was torn shifting it downwards.
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F1
The child had complete avulsion injury of the nasal bones and nasal septum from the glabella in the anterior 1/3 continuing with an inferiorly based flap to upper lips and both the cheeks, the cartilaginous septum was separated from the white perpendicular plate of the ethmoid, the left medial canthus ligament was torn shifting it downward, degloving injury of the face (Fig. 1).
(a) Contaminated lacerated wounds over the right inguinal region and right lower leg measuring 15 x 4 cm and 5 x 4 cm, respectively, were noted (b and c) Multiple extensive degloving injuries were noted over the left groin, thigh, leg, and foot.
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F2
CLWs over the right inguinal region and right lower leg measuring 15 x 4 cm and 5 x 4 cm respectively were noted (Fig. 2a). Multiple extensive degloving injuries were noted over the left groin, thigh, leg, and foot (Fig. 2b and c).
(a) Radiographs of the lower extremities revealed an AO 42-A3 fracture on the right side and (b) AO 42-B3 on the left side.
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F3
Radiographs of the lower extremities revealed an AO 42-A3 fracture on the right side (Fig. 3a) and AO 42-B3 on the left side (Fig. 3b).
Post-operative radiograph of left tibia showing fracture fixation with two interfragmentary screws and neutralizing ankle-spanning external fixator.
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F4
Fixation was performed with two interfragmentary screws and neutralizing ankle-spanning external fixator (Fig. 4).
Clinical picture depicting wound closure of both lower limbs and external fixator application.
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F5
Subsequently, wound closure was done (Fig. 5).
Post-operative radiograph of right tibia showing fixation with closed elastic stable intramedullary nailing.
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F6
The right tibia shaft fracture was treated with closed elastic intramedullary nailing (Fig. 6).
(a-c) The patient underwent debridement of wounds and vacuum-assisted closure dressing 3 times with split skin grafting for the left leg.
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F7
Subsequently, the patient underwent debridement of wounds and vacuum-assisted closure (VAC) dressing 3 times with split skin grafting for the left leg under general anesthesia (Fig. 7a, Fig. 7b, c) and was discharged without any complication after 30 days.
(a and b) All wounds healed well within 3 months with minimal scarring over the face.
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F8
All wounds healed well within 3 months (Fig. 8a and b).
(a and b) Radiographs at 4 months showed complete healing of the right tibia shaft fracture and partially united left comminuted tibia shaft fracture.
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F9
Radiographs at 4 months showed complete healing of the right tibia shaft fracture and partially united left comminuted tibia shaft fracture (Fig. 9a and b).
(a and b) The child was able to do daily routine activities at 6 months without any functional limitations.
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F10
All fractures healed well at 6 months and the child was able to do all activities without any functional limitations (Fig. 10a and b).