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Reconstructive surgery of  lower limb

Reconstructive surgery of the lower limb in Madrid

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When?

Reconstructive surgery of the lower limb is usually performed due to loss of bone or skin coverage after accidents, infection or tumors. When the skin is not enough to close and cover the bone, flaps are needed, that is, tissue transplants (usually skin and / or muscle) from other parts of the body.

Clinical presentation

Manifestations of chronic wounds in the lower extremity can be:

  1. Open wounds, which do not heal or present necrotic plaques (crusts).
  2. Infection, with pain, redness of the skin and / or discharge of pus.
  3. “Unstable” scars: These are scars attached to the bone that produce chronic pain and wounds.
  4. Pseudoarthrosis (nonunion): failure of bone healing. It produces pain and instability.
Diagnosis

In addition to the medical history and physical examination, specific tests that assess the different structures may be necessary:

  • Skin or soft tissues: visual examination of the wound.
  • Blood vessels: visualized by arteriography or CT angiography.
  • Bone: visualized by X-ray or computed tomography (CT). If signs of bone infection are suspected, an MRI may be required.
  • Nerves: electrophysiology tests.
Treatment

Treatment of this type of injuries usually requires multidisciplinary management, that is, by different specialists (multidisciplinary team).

  1. Skin or soft tissue defect: The plastic surgeon often uses transplants of local tissue (called local or pedicled flaps) or from other parts of the body (called free flaps) to reconstruct the affected areas and, if necessary, protect the osteosynthesis material placed by the orthopedic surgeon.
  2. Bone fracture: the orthopedic surgeon uses osteosynthetic material (plates, screws, etc.) to treat the fracture.
  3. If there is a bone infection, an unstable scar, or pseudoarthrosis, debridement (removal of infected tissue, painful scar, or unhealthy bone) is required prior to reconstruction.

After the surgical treatment of these injuries, an intensive rehabilitation plan and a high degree of motivation and effort of the patient are required.

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