A 35-year old patient, Deshraj Yadav met with a gruesome accident. He found his toes cut by a tile cutter on the 1st of January, 2020. He was immediately brought to the emergency for treatment and was bleeding excessively. Dr. Shree Harsh was on the case who revealed the following:
The patient had near total amputation of the left foot with all the phalanges being damaged. He also observed cuts in the tendons and neuro-vascular structure of the foot. His 5th toe had crush elements while all the others were fractured till the metatarsophalangeal joints region.
The doctors, Dr. Shree Harsh (Director, Chandan Institute of Plastic Surgery) and Dr. Naveen Srivastava (Director, Chandan Institute of Orthopaedics) immediately took Deshraj into the OT. Dr Shree Harsh performed the revascularization surgery on him which was preceded by K-wire Fixation of the fractured bones by Dr Naveen Srivastava in order to save the amputated part of the foot.
Revascularization is the restoration of perfusion to a body part or organ that has suffered ischemia (restriction in blood supply to tissues)
In this process, the cut vessels, nerves, tendons and bones are dissected and reattached under microscope. For this case, the artery and veins supplying the foot were dissected under magnification and added to the cut vessels of the injured foot.
Since there was soft tissue loss in the foot after debridement and the vessels were exposed, there was a need to save them as they get desiccated once exposed. In order to save the foot, we needed to cover that with soft tissues in the form of skin graft.
Dr. Naveen performed the K-wire Fixation to repair the phalanges of the foot helping the patient in movement of the foot while Dr. Shree Harsh repaired 5 arteries, 7 veins, extensor tendons and nerves. The patient was put on a high protein diet and was asked to keep his foot elevated. He was discharged on the 8th of January in a stable condition.