Chapter 46
Lower limb reconstruction
James K. Chan,
Matthew D. Gardiner,
Michael Pearse,
Jagdeep Nanchahal,
James K. Chan
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for more papers by this authorMatthew D. Gardiner
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for more papers by this authorMichael Pearse
Department of Orthopaedics, St Mary's Major Trauma Centre, Imperial College Healthcare NHS Trust, London, UK
Search for more papers by this authorJagdeep Nanchahal
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for more papers by this authorJames K. Chan,
Matthew D. Gardiner,
Michael Pearse,
Jagdeep Nanchahal,
James K. Chan
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for more papers by this authorMatthew D. Gardiner
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for more papers by this authorMichael Pearse
Department of Orthopaedics, St Mary's Major Trauma Centre, Imperial College Healthcare NHS Trust, London, UK
Search for more papers by this authorJagdeep Nanchahal
Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
Search for more papers by this authorBook Editor(s):Ross D. Farhadieh BSc(Med)Hons, MBBS, MD, EBOPRASF, FRACS(Plast), FRCS(Plast),
Neil W. Bulstrode BSc(Med)Hons, MBBS, MD, FRCS(Plast),
Sabrina Cugno MD, MSc, FRCSC,
Ross D. Farhadieh BSc(Med)Hons, MBBS, MD, EBOPRASF, FRACS(Plast), FRCS(Plast)
Panthea Plastic Surgery Clinics, Sydney and Canberra, Australia and Australian National University, Canberra, Australia
Search for more papers by this authorNeil W. Bulstrode BSc(Med)Hons, MBBS, MD, FRCS(Plast)
Clinical Lead Plastic Surgery
Great Ormond Street Hospital, London, UK
Search for more papers by this authorSabrina Cugno MD, MSc, FRCSC
Assistant Professor
McGill University, Department of Plastic Surgery, Montreal Children's Hospital, Montreal, Canada
Search for more papers by this authorFirst published: 27 March 2015
Summary
Severe open fractures are best managed jointly by plastic and orthopaedic surgeons from the outset. Following a thorough clinical examination the wound is debrided and the skeleton stabilized. Internal fixation is only performed prior to definitive soft tissue reconstruction. Negative-pressure wound therapy is used as a temporary dressing until vascularized soft tissue reconstruction is undertaken. A devascularized limb requires immediate surgical exploration. The use of vascular shunts will dramatically reduce ischemic time. Compartment syndrome can occur in open fractures and all four compartments should be decompressed and debrided. Early primary amputation may be the best reconstructive option for patients with severe injuries.
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