Subacute Open Ankle Fracture-Dislocation in a Medically Comorbid Patient

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Patient History

Elderly male with significant medical comorbidities (vascular disease, diabetic neuropathy) presented with a 3-week-old open ankle fracture. Deemed not a soft tissue reconstructive candidate by plastics service; patient refused amputation and elected for limb salvage.

Treatment

The open fracture was debrided and stabilized with a primary antibiotic hindfoot rod. Devitalized skin was primarily closed over a Restrata Sheet for reinforcement.

Conclusion

The area of devitalized skin predictably became necrotic in clinic follow up. The eschar was debrided in clinic and a base of healthy granulation tissue was present in the wound base. The wound healed by secondary intent and local wound care. The patient went on to obtain a formal tibiotalocalcaneal (TTC) fusion nail and avoided amputation with a healed, infection-free soft tissue envelope.

PRESENTATION

Initial presentation with devitalized medial ankle skin | Subacute ankle dislocation

DAY 0

Primary closure achieved with subcutaneous Restrata Sheet as reinforcement, directly underneath the skin region of concern | Antibiotic rod for bony stabilization pending soft tissue declaration

WEEK 3

Declaration of skin necrosis

WEEK 5

Robust granulation tissue at wound base after bedside eschar debridement

WEEK 8

Local wound care

WEEK 12

Healed soft tissues with local wound care

Successful TTC nail arthrodesis

Please refer to product Instructions for Use for a full list of indications, contraindications, precautions, and warnings.

MKG-30234-00

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