Secondary Limb-Salvage Fifty Years After Vascular Injury: A Case Report

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Reconstructive Surgery

Background:

• A 73-year-old veteran presented with a chronic, nonhealing left lower leg wound.
• The wound stemmed from a gunshot injury sustained 50 years prior, initially treated with superficial femoral artery to popliteal artery bypass.
• Current presentation revealed infected myositis ossificans and bypass occlusion, with amputation initially considered.

Purpose of the Study:

• To describe the successful secondary limb salvage in a veteran with a complex, long-standing post-traumatic lower extremity wound.
• To detail the management of infected myositis ossificans and occluded arterial bypass in a limb salvage scenario.

Main Methods:

• Serial radical debridement of myositis ossificans.
• Revision of the superficial femoral artery to popliteal artery bypass using a reverse great saphenous vein graft.
• Soft-tissue reconstruction utilizing dermal replacement and split-thickness skin grafting.

Main Results:

• Successful limb salvage was achieved, avoiding amputation.
• The revised bypass demonstrated assisted primary patency.
• Satisfactory wound healing and functional limb recovery were obtained.

Conclusions:

• Complex post-traumatic lower extremity wounds, even with complications like myositis ossificans and bypass occlusion, can be managed with secondary limb salvage.
• Multidisciplinary surgical intervention, including debridement, bypass revision, and reconstructive techniques, is crucial for successful outcomes.