Tendoachilles Reconstruction - Reverse sural flap

Patient was referred to us with a raw area over achilles tendon area. Due to injury, the patient had rupture of his achilles tendon and also there is loss of the overlying skin. The Tendoachilles is repaired and the raw area with exposed achilles tendon has to be covered. Sural fasciocutaneous flap based on the reverse circulation from Sural nerve and its surround vascular structures and also the last perforator of the peroneal vessels around 5-7 cm above the lateral malleolus was elevated. The flap is also elevated on a adipofascial pedicle which increases the flap survival. The raw area was covered with the above mentioned flap and the donor raw area was covered with skin graft.

The picture shows a well healed flap covering the raw area with exposed achilles tendon.

Crush injury left arm and forearm - Skin grafting

This child around 13 years suffered crush injury of left arm, elbow and forearm due to road traffic accident - her arm and forearm got stuck between road and tractor. Luckily her limb was saved as there was no severe vascular or other important structures of the forearms. The skin of the arm, elbow and forearm was crushed and lost. Some muscle and the ligaments over the arm and elbow were crushed and had to be removed. The resultant wound was treated with negative pressure wound therapy and once the wound was better and covered with healthy granulation, skin grafting was done. The final photograph shows a well healed skin graft and normal function of the left upper limb.

Finger contracture - Release and Skin grafting

This 12 year girl presented with contractures of varying degrees of left middle, ring and little fingers. The contractures were released and the resultant raw area was covered with skin grafts. Post operative photos after healing shows completely flat fingers suggesting complete release.

Abdominal flap due to extravasation cellulitis left arm

Patient came with necrosis of the skin over wrist volar aspect secondary to extravasation of chemotherapeutic agents for breast cancer. After proper debridement the exposed tendons of the wrist were covered with abdominal flap. 

Post intramuscular injection wound with mycobacterial infection - treated by skin grafting

This is a patient referred to oped with infected wound right arm secondary to intramuscular injection. Prompt debridement is done and patient was kept on regular dressings. But the wound did not improve and further there was a fluffy growth appeared which on investigation was an atypical mycobacterium. Prompt Antitubercular therapy was started and within days the improvement of the wound was visible. After the wound was healthy enough to sustain a skin graft, Skin grafting was done and the grafts healed well as seen in the picture