Case Presentation of Soft Tissue Defect after Bimalleolar Fracture Osteosynthesis.

Area of Science:

• Orthopedic Surgery
• Plastic and Reconstructive Surgery
• Wound Healing Research

Background:

• A 59-year-old patient presented with severe right ankle wound dehiscence and skin necrosis post-osteosynthesis for a bimalleolar fracture.
• The initial open reduction and internal fixation with plate and screws, performed abroad, led to a critical surgical site complication within 16 days.

Purpose of the Study:

• To document the management and successful outcome of a complex post-operative wound complication involving skin necrosis and dehiscence.
• To evaluate the efficacy of a multi-modal treatment approach including surgical debridement, negative-pressure wound therapy, and platelet-rich plasma therapy.

Main Methods:

• Initial surgical debridement of necrotic tissue was performed.
• Post-operative management included Negative-pressure wound therapy (VAC dressing) and Platelet-rich plasma (PRP) therapy.
• A sural fasciocutaneous flap was utilized to cover the resultant skin defect after granulation tissue formation.

Main Results:

• The patient's wound showed granulation tissue formation without signs of infection after initial debridement and advanced therapies.
• The sural fasciocutaneous flap demonstrated proper graft integration.
• Complete healing of the complex ankle wound was achieved.

Conclusions:

• A combination of surgical debridement, Negative-pressure wound therapy, and Platelet-rich plasma therapy can effectively manage severe post-operative wound complications.
• Fasciocutaneous flap coverage is a viable reconstructive option for significant skin defects following osteosynthesis complications.
• This case underscores the importance of timely and aggressive multi-modal treatment in achieving favorable outcomes for complex wound healing challenges.