NEW DELHI: When three modern surgical procedures failed, a 170-year-old surgical technique came in handy to save the leg of an Iraqi national from being amputated. The 40-year-old man from Iraq was involved in a road accident in October last year which damaged his leg severely. He had to undergo three surgeries in Iraq over a period of eight months but all were unsuccessful and the condition further deteriorated.
To seek better treatment, the patient came to India and was admitted to Fortis Hospital, Delhi in May this year. “He was brought with acute dislocation of the left knee joint and a severely infected and pus-oozing leg. Investigations revealed that the patient’s affected leg had no intact blood vessel due to multiple injuries, which is necessary for the reconstructive surgeries currently in vogue,” the hospital said in a statement.
The doctors said the case posed a big challenge since the precarious condition of the patient did not allow them to use new surgical options. “The patient suffered from a severe infection and poor bone quality. He was hypertensive and diabetic too. Both his legs overlapped each other, and he had to be kept in that position for three weeks. It was a task to ensure that there’s no pressure and bending of flap between both feet. It required planning and patient’s cooperation,” said Dr Rashmi Taneja, Director, Plastic and Reconstructive Surgery, Fortis, Vasant Kunj.
“We initially thought of doing a micro vascular free flap reconstruction, which involves taking muscle and skin along with the blood vessels from either the back or the abdomen, but dropped the idea as there was no intact blood vessel in the patient’s leg,” she added. The doctors decided to perform the cross-leg flap surgery, first described in medical literature in 1854. The surgery was successful and the patient is recovering, doctors said.
A flap surgery involves lifting tissue from a donor site and placing it on the recipient site with an intact blood supply. However, the technique fell into disuse with the advent of highly sophisticated micro vascular techniques, which enable doctors to join or repair damaged blood vessels or nerves.
“We decided to adopt a complex, multi-step approach.
Though the treatment spanned over five weeks, the outcome was satisfactory. Presently, the patient’s leg is well-covered with soft tissue and there is no evidence of infection. The patient has been asked to start walking and he is currently undergoing physio rehabilitation,” said Dr Dhananjay Gupta, Director, Orthopaedics & Joint Replacement Surgery, Fortis Vasant Kunj.