|| FIG. 20-13. The transferred muscle was anastomosed to the posterior tibial vessels. A pH probe and laser Doppler head were used to monitor muscle circulation.
FIG. 20-14. Early view of the skin-grafted muscle.
FIG. 20-15. Late result shows shrinkage of the muscle. Such shrinkage occurs to a variable degree: about 50% with no nerve hook-up, 40% when the motor nerve is connected to a sensory nerve, and 20% when motor nerve to motor nerve is repaired.
FIG. 20-16. The patient was particularly pleased with her abdominoplasty.
A 50-year-old man had fallen from a horse at age 12 and fractured his distal tibia. He was casted and walked with crutches for 2 years. Two years before admission, he developed pain and drainage in the wound above the medial malleolus.
FIG. 20-17. Debridement elsewhere resulted in the present wound.
FIG. 20-18. X-ray shows large osteomyelitic cavity in the distal tibia.
FIG. 20-19. Thorough debridement of the infected bone produced a sizable defect. Bone cultures are always taken for specific antibiotic coverage.
FIG. 20-20. After several days of moist dressing changes every 4 hours, the wound is ready for closure. Intravenous antibiotics are given for 5 to 6 weeks postoperatively.
FIG. 20-21. A left rectus was developed through a paramedian incision.
FIG. 20-22. The muscle was "stuffed" into the wound to obliterate all dead space.
FIG. 20-23. Wound closure must be three-dimensional or infection will recur.
FIG. 20-24. X ray of bony defect which was bone grafted at a later date.
FIG. 20-25. Early postoperative appearance.
FIG. 20-26. Final appearance of wound.
A 36-year-old roofer fell from a ladder at work, sustaining an open fracture of the distal right tibia and fibula. This was treated at his local hospital by ORIF with screws and plates. He was referred after skin breakdown over the plate.
FIG. 20-27. X ray of hardware.