Open Wound: Middle Third of Leg
Description
Open wound of the middle third of the right leg
Gustilo grade III C (see Table 21.1): Severely comminuted bone and soft-tissue defect with vascular compromise.
A 35 × 20-cm soft-tissue defect, and a 16-cm tibial bicortical bony defect.
Work-up
History
Etiology
Traumatic: Mechanism of injury. Evaluate for concomitant injuries.
Tumor resection: Extent of resection.
Chronic: Etiology of wound and history of previous management.
Comorbidities of prognostic significance
Peripheral vascular disease, cardiovascular disease, diabetes, smoking history, nutritional status, steroid use, radiation treatment.
Physical examination
In trauma cases, evaluate ABCs (airway, breathing, circulation).
Wound assessment
Soft-tissue damage: Size of wound, depth, zone of injury.
Degree of contamination, exposure of vital structures.
Vascular supply to lower extremity, extent of bony defect.
Vascular examination
Examine pulses, temperature, color, turgor.
Ankle–arm index (AAI) measurements, Doppler examination.
Neurologic examination: Check for peroneal or tibial nerve injuries.
Rule out compartment syndrome.
Compromised neurovascular status.
Pain out of proportion to injury on flexion and extension of extremity.
Compartment pressures > 30 mm Hg.
Pertinent imaging or diagnostic studies
Plain films: Evaluation of bony injuries.
Arteriography: Emergent if vascular status threatened; elective procedure if plan for free flap reconstruction.
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