Challenges of limb salvage in a resource limited environment: Case report and review of literature

Abstract

Complex lower extremity injuries pose a significant challenge in terms of management especially when the distal leg is involved. This is compounded by the fact that many patients in this environment who sustain fractures present to traditional bone setters before presenting to the hospital often with complications. We present a 26 year old man with severe right leg injury following a road traffic accident who presented to us at Ntasiobi Specialist Hospital, Enugu, Nigeria for amputation through a traditional bonesetter. He had comminuted fractures of the tibia and fibula with periosteal stripping and an extensive soft tissue loss affecting the distal ½ and about ⅔ of the circumference of the right leg. This degree of injury required free flap reconstruction which was not feasible. We used external fixator to stabilize the bones and improvised negative pressure dressing with a delayed distally based posterior calf fasciocutaneous flap for wound cover. The limb was salvaged though with some challenges but patient was satisfied with the outcome.