Long-term follow-up of a severely traumatized leg treated with ipsilateral fracture-united fibular transfer in a patient with amputation of the contralateral leg: a case report

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

Penatalaksanaan kegawatdaruratan medis trauma maksilofasial pada anak disertai cedera kepalaEmergency management of maxillofacial trauma in children with a head injury

Pendahuluan: Pasien dengan fraktur maksilofasial mempunyai risiko tinggi disertai cedera kepala karena dekatnya letak anatomi tulang wajah dan kranium. Trauma maksilofasial sering menyebabkan cedera pada jaringan lunak, gigi geligi dan komponen utama rangka wajah termasuk mandibula, maksila, zigoma, kompleks nasoorbital-ethmoid (NOE) dan struktur supraorbital. Kegawatdaruratan medis pada anak merupakan suatu kondisi yang mendesak yang membutuhkan penanganan segera pada anak untuk mengurangi resiko kematian dan kecacatan. Laporan kasus ini bertujuan agar memberikan gambaran dan mengevaluasi tindakan pasien trauma maksilofasial yang disertai cedera kepala pada anak. Laporan kasus: Seorang anak laki-laki usia 9 tahun datang dengan keluhan perdarahan dari mulut, 3 jam karena terjatuh saat mengendarai sepeda. Pasien mengalami cedera kepala dan fraktur dentoalveolar rahang atas dan rahang bawah. Diagnosis cedera kepala ringan, fraktur palatum inkomplit, fraktur dentoalveolar regio gigi 54-21, 85-32 dengan fraktur segmental dentoalveolar regio gigi 42-83 disertai avulsi gigi 11,12,53,54,21,32,31,41,84 dan mobility grade 3 gigi 42,83,85, luka laserasi pada regio frontal, labii inferior, palatum, mentale dan gingiva regio gigi 54-21 dan 85-32, serta luka punctum pada regio labiomental. Penatalaksanaan kasus ini adalah dilakukan pembersihan luka, ekstraksi gigi 83, 85, 42, alveolektomi regio gigi 54-21, 32-85 serta penjahitan pada luka laserasi dan punctum dengan melibatkan bagian bedah saraf, ilmu kesehatan anak dan anestesi. Simpulan: Penatalaksanaan kegawatdaruratan medis cedera kepala dan trauma maksilofasial pada kasus ini dilakukan penjahitan pada intra oral dan ekstra oral serta ekstraksi gigi 42,83,85 dengan anestesi umum yang melibatkan bagian bedah saraf, ilmu kesehatan anak, anestesi dapat mencegah kematian dan mengurangi resiko kecacatan yang lebih parah. Penilaian awal secara komprehensif sangat penting dalam menentukan rencana perawatan kegawat daruratan pada pasien trauma maksilofasial.Kata kunci: Cedera kepala, trauma maksilofasial, kegawatdaruratan medis anak ABSTRACTIntroduction: Patients with maxillofacial fractures are at a high risk of head injury due to the cranium and facial bones' anatomy. Maxillofacial trauma often causes injury to soft tissues, teeth, and significant facial skeleton components, including the mandible, maxilla, zygoma, nasoorbitoethmoid (NOE) complex and supraorbital structures. A paediatric medical emergency is an urgent condition that requires immediate treatment to reduce the risk of death and disability. This case report was aimed to provide an overview and evaluation of the treatment for child patient with maxillofacial trauma accompanied by head injuries. Case report: A 9-year-old male child presented with complaints of bleeding from the mouth, 3 hours after falling while riding a bicycle. The patient had head injuries and dentoalveolar fractures of the maxilla and mandible. Diagnosis of minor head injury, incomplete palatal fracture, dentoalveolar fracture of teeth number 54-21, 85-32 with segmental fracture of the dentoalveolar region of teeth number 42-83 accompanied by avulsion in teeth number 11, 12, 53, 54, 21, 32, 31, 41, 84, and mobility grade 3 of teeth number 42, 83, 85. Laceration wounds in the frontal region, inferior labii, palate, mentale, and gingiva regions of teeth number 54-21 and 85-32, and punctum wounds in the labiomental region. This case management included rinsing the wound; extracting teeth number 83, 85, 42; alveolectomy in the region of teeth number 54-21, 32-85; suturing the laceration and punctum wounds involving neurosurgery, paediatric medicine and anaesthesia. Conclusion: Management of medical emergency of head injury and maxillofacial trauma in this case is performed with intraoral and extraoral suturing and extraction of teeth number 42, 83, 85, with general anaesthesia involving the Neurosurgery and Paediatrics Division. Anaesthesia can prevent death and reduce the more severe risk of disability. A comprehensive initial assessment is essential in determining the emergency treatment plan for maxillofacial trauma patients.Keywords: Head injury, maxillofacial trauma, paediatric medical emergency.