By Health In Five Writer
A team led by Dr Parag Sahasrabudhe, a Plastic and Reconstructive Surgeon at Lokmanya HSS, Pune successfully performed complex and complicated limb saving surgery on a 21 year old, road accident patient Prajakta Joshi (name changed) using a Dermal Regeneration Templates, a new technology in India to give her a new lease of life.
Joshi underwent a massive road traffic accident because of collision with a heavy duty dumper which dragged her along the roadside leading to severe injury to her left lower limb. The entire left leg from her thighs downwards had degloving injury with loss of skin circumferentially from her lower thigh to the ankle joint. She also had severe damage to her leg muscles.
In an emergency, she was moved to a nearby hospital, where doctors told amputation of the leg. It was a shocking moment for parents. They spoke with their family doctor at their hometown, who suggested them to get a second opinion with Dr. Sahasrabudhe.
Dr. Sahasrabudhe said, “Family sent us the photos of accident victim. The condition of patient leg was very bad, as there was total skin loss from mid-thigh to ankle circumferentially.” It made a surgery complicated because of following reasons:
- There was no skin available to cover such a large defect with exposed and open shin bone, and conventional reconstructive surgery technique( Microvascular flap surgery) was risky and inadequate to cover such a large wound.
- Patient was morbidly obese.
- The blood circulation in the limb was compromised and zone of injury was wide hence microsurgical reconstruction was risky.
- There was severe contamination in the wound by mud, stones, grease etc. which could have led to infection and eventually amputation of the leg.
Dr Sahasrabude further elaborated, “The patient was admitted at Lokmanya Hospital, Senapati Bapat Road, Pune. She was in pain and tears and bleeding from the leg wound. The circulation in the left leg was compromised but she had good sensations in her toes and foot. The girl was very young and losing her leg could destroy her future. As microsurgical reconstruction was ruled out because of above reasons the real challenge was to cover entire open bone which required complex and complicated limb saving surgery. We succeeded by using Dermal Regeneration Templates, a new technology in India along with negative pressure wound therapy and conventional reconstructive surgery techniques.
“She was taken up for surgery immediately after arrival and the wound was thoroughly cleaned. The entire shin bone was bare devoid of any soft tissue cover and was open in the wound. After thorough cleaning to prevent wound from getting infected a negative pressure dressing (an established wound therapy) was applied to the wound”, added Dr Sahasrabude.
At next surgery, the challenge was to cover the entire shin bone which had lost its dermal cover. Just applying partial thickness skin graft was not an options as it does not take up on bare bone without the soft tissue- dermis layer. The technique of muscle flap surgery was used to cover upper one third of shin bone along with new advanced technology in the wound management — dermal regeneration template was used to cover the remaining lower two third shin bone.
According to him, Dermal Regeneration Template is a double layer skin regeneration system. The outer layer is a silicon film that acts as skin epidermis (outer skin layer). It protects wound from infection and maintains wound moisture required for the healing. The inner layer is made up of complex matrix of cross linked fibers. This porous material acts as scaffold for regenerating dermal skin cells which enables growth of dermis the inner skin layer in the wound. Once dermal layer is regenerated outer silicon layer separates and needs to be replaced with partial thickness skin graft.
“The main task was to make sure she is kept away from the infection throughout this procedure as infection can melt away this dermal regeneration template quickly. We could prevent infection with use of appropriate antibiotics, aggressive surgical wouns cleaning and early wound cover along with hygienic and sterile environment in her room throughout her hospital stay.
After ensuring that there was no infection and dermal regeneration template was well integrated in the wound, she was taken up a partial thickness skin grafting which was done in two stages to cover the entire circumferential skin loss from mid-thigh to ankle joint. As available donor skin was limited, we used skin graft mesher to expand the skin so that we cover the wound in totality. All the applied skin graft was taken up well all over the wound , even over the dermal template and wound was almost fully covered in a month’s time after the date of the accident.”
The girl was discharged from the hospital after three weeks from admission and her recovery was miraculous. Her fighting spirit and determination to walk helped her recover from such a major trauma remarkably.
With the help of conventional technique of muscle flap surgery, negative pressure wound therapy and advanced wound therapy of dermal regeneration template system, Joshi’s limb was saved from amputation.