Open Wound: Upper Third of Leg



10.1055/b-0034-97711

Open Wound: Upper Third of Leg

Leahthan Domeshek & Thomas H. H. Tung
A 15-year-old girl presents following an all-terrain vehicle (ATV) accident with soft-tissue injury to the right leg.


Description




  • Open wound involving the proximal half of the right lower extremity




    • The proximal third of the anterior tibia is exposed with no evidence of periosteum. However, no clear fracture of the bone is visible.



    • The medial gastrocnemius muscle is exposed.



    • Tissue loss is present over the proximal half of the anterior–medial right leg measuring ~ 25 cm in length (based on visible ruler).



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.



  • Age, comorbidities (diabetes, peripheral vascular disease, coronary artery disease, smoking history), nutritional status, steroid use, history of radiation treatment.



Physical examination




  • In trauma cases, evaluate ABCs, use ATLS protocol.



  • Gustilo classification of open tibial fractures (Table 21.1).

































    Gustilo classification of open tibial fractures

    Grade

    Wound

    Bony injury

    I

    < 1 cm, clean, minimal soft-tissue injury

    Simple, with minimal comminution


    II

    > 1 cm, moderate contamination, moderate soft-tissue injury

    Moderately comminuted fracture


    III A

    < 10 cm, crushed tissue and/or contamination; local coverage usually possible

    Significant contamination or segmental bone loss, possible vascular injury, highly contaminated wound, high-velocity injury


    III B

    > 10 cm, crushed tissue and/or contamination; inadequate soft tissue; requires regional or free flap


    As above


    III C

    Major vascular injury requiring repair for limb salvage; amputation necessary in some cases

    As above



  • Vascular status: Pulses, temperature, color, turgor, ankle-arm indices.



  • Neurologic examination (especially sensation on plantar surface of foot).



  • Evaluate for compartment syndrome.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Open Wound: Upper Third of Leg

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