Lower Limb – Trauma

This little 4 year old boy was run down by a Garbage truck, while walking on side of the road outside his playgroup school. Little could he have comprehended about the incident that had scarred his life forever.
He was immediately shifted to Municipal Hospital for primary care.
The surgeons at Municipal Hospital advised him amputation, but his father was did not give consent and brought him to Saifee Hospital with a hope for a miraculous salvage of the limb.
On admission, it was noted that there was a crush– avulsion injury of the right leg extending from the gluteal region to the mid calf. His distal part of the femur, remnants of patella and the knee joint were exposed with slough and pus discharging through the wound; the sciatic nerve had been avulsed too. External Fixators had been placed at the primary hospital to stabilize his leg at the knee joint.
The Femoral artery was thrombosed as diagnosed on the Angiograph, however, capillary reflux of the toes were normal.
After thorough debridement and removal of the necrotic bone fragments, cross leg flap was done to cover the exposed distal end of femur and the knee joint.
The limb is shorter but viable and patient is walking with a limp.
An expandable knee joint replacement is being considered now.

Pre Operative condition of limb

After debridement

Skin grafting

Cross leg flap

After division of cross leg flap

Post Operative 3 months

Post Operative X ray