Patient History
An 18-year-old male presented with a GA type IIIA open right tibia/fibula fracture with intra-art extension following a motor vehicle vs. pedestrian accident. The injury was associated with significant traumatic soft tissue damage requiring operative management.
Treatment
At the index procedure, the traumatic wound was extended proximally and distally to facilitate adequate exposure and thorough excisional debridement. Devitalized bone and nonviable soft tissue were removed. Following debridement, the fracture was stabilized using a combined intramedullary nail and plate construct. A Restrata® solid sheet was placed between the fracture segment and the overlying subcutaneous tissue to support healing of the severely traumatized soft tissue envelope and provide incisional reinforcement to the primary closure.
The patient was subsequently lost to routine postoperative follow-up and underwent premature suture removal by an outside physician. He later returned with traumatic wound breakdown and overlying eschar formation. The eschar was excised, revealing a healthy granulation tissue bed without exposed bone or hardware. The wound was successfully reclosed, and internal fixation was retained without the need.