Multi-plane external fixator for deformity correction and application of skin substitute for complex lower extremity wound healing and limb salvage: case report.

Introduction: A case report was compiled for a complicated patient who had multiple co-morbidities, significant varus deformity, complex wound and at high risk for amputation of the affected limb. Patients experiencing challenges associated with healing full-thickness wounds are often faced with complications that include long hospital stays, wound infection, osteomyelitis and limb loss. In this case report, surgical intervention and various advanced wound closure methods were utilized when a very high risk of proximal amputation was present.Methods:Case report includes a female patient with diabetes, neuropathy, prior partial amputation of left forefoot, chronic ulceration and significant varus deformity and instability of the foot and ankle preventing the patient from normal ambulation without assistance. The patient developed a large lateral foot wound secondary to pressure. Application of hexapod multiplane external fixator was placed for progressive deformity correction with adjustments to struts performed three times per day. Application of fish skin graft was placed after extensive wound debridement and preparation, initially with micronized graft for the deep soft tissue void and then sheet graft overlying the rest of the wound surface.Results:Rectus alignment of the left foot and ankle was achieved after four weeks and then held in place for another two weeks with the external fixator before the removal. Plan for definitive deformity correction with placement of intramedullary rod and tibiotalocalcaneal arthrodesis. Advanced adjunct therapies (application of fish skin graft) in combination with conventional wound therapy including weekly wound debridement achieved complete healing. The patient remains healed.Discussion: A combination of surgical intervention, application of external fixation, application of skin substitute and other advanced modalities are often required for patients with complex medical conditions for successful limb salvage. This case report exemplifies that a complete clinical picture needs to be considered for long term limb salvage.References: