Thin and superthin free flaps: An innovative approach to pediatric extremity reconstruction.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of Competing Interest The authors have no conflicts of interest to declare 18. BMJ Case Rep. 2023 Jun 15;16(6):e254629. doi: 10.1136/bcr-2023-254629. Salvage of a severely mangled limb following traumatic injury. Jha RK(1), Jayaram PV(2), Shankaran R(1), Pillai HJ(3). Author information: (1)Department of Surgery, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India. (2)Department of Surgery, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India prasad59@gmail.com. (3)Department of Surgery, INHS Jeevanti, Vasco-de-Gama, Goa, India. Management of a severely damaged extremity poses a dilemma-whether to perform a primary amputation or attempt limb salvage. A multitude of factors-such as the extent of neurovascular injury, limb ischaemia time, severity of bone and soft tissue loss, physiological reserve of the patient and availability of surgical expertise and resources-influence this decision. The Mangled Extremity Severity Score (MESS) was developed as a predictor of the need for limb amputation, and a MESS of 7 or more is considered a predictor of primary amputation. Here we describe a case where a man in his 20s sustained traumatic avulsion of his right ankle with severe neurovascular damage and multiple tendon injuries onboard a ship at high sea. Despite a MESS of 10, limb ischaemia time of more than 10 hours and injuries to all three extremity vessels (anterior tibial, posterior tibial and peroneal arteries), limb salvage was successfully carried out at a level-II trauma centre. © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ. DOI: 10.1136/bcr-2023-254629 PMCID: PMC10277066