Pune: A two-stage Ortho-Plastic procedure on a 60-year-old man has helped save his limb following a traumatic road accident. The procedure was led by Dr. Swaminathan Ravi, Plastic and Reconstructive Surgeon at Noble Hospitals and Research Centre.
The patient, who was riding a two-wheeler, met with an accident after being hit by a truck on Shikrapur Road. The truck tyre went over his leg, resulting in a compound fracture, vascular injury and severe soft tissue, skin and muscle loss.
Dr. Swaminathan Ravi, Plastic and Reconstructive Surgeon at Noble Hospitals, said, “We went with a combined ortho-plastic approach which includes two stages.”
First Stage of Ortho-Plastic Treatment
The first stage of the Ortho-Plastic procedure involved thorough debridement. This included a carefully planned, three-step approach to manage the severe wound and unstable fracture.
The surgical team first thoroughly cleaned the wound and removed dead, damaged and contaminated tissue, along with loose bone fragments that could increase the risk of infection.
The fracture was then stabilized using an external fixation device. In this procedure, pins are placed into healthy bone and connected to a frame outside the body. This helps keep the bone properly aligned while allowing doctors to access and treat the wound.
The final part of the first stage involved Vacuum-Assisted Closure (VAC) therapy, also known as Negative Pressure Wound Therapy. A special foam dressing connected to a controlled suction system was applied to the wound.
The therapy helps remove excess fluid from the wound, supports the formation of healthy tissue and creates a better environment for healing. This initial Ortho-Plastic intervention prepared the injured limb for definitive soft-tissue reconstruction.
Second Stage Involved Microvascular Free Flap
The second stage of the Ortho-Plastic procedure was performed within the next 72 hours and involved a microvascular free flap.
A microvascular free flap is an advanced reconstructive surgery used to repair large and complex wounds. In this procedure, healthy tissue such as skin, muscle, fat or bone is taken from another part of the patient’s body and carefully transferred to the injured area.
The tiny blood vessels of the transferred tissue are then connected to blood vessels at the wound site using a surgical microscope. This allows the transferred tissue to receive a fresh blood supply and survive.
In this case, a large tissue flap measuring almost 30 cm x 18 cm was transferred from the right thigh to the wounded left leg.
Dr. Vishal Chaudhari, Head of Department of Trauma and Spine at Noble Hospitals and Research Centre, said that the procedure can be particularly important after severe trauma, when a large amount of damaged tissue has been removed and bone or surgical hardware is exposed.
The free flap provides healthy, well-blooded tissue to cover the exposed area, fill large defects and create better conditions for healing. It can also help reduce the risk of persistent infection in severely damaged wounds and support efforts to save the affected limb.
Dr. Chaudhari added that once the wound healed in about four weeks, the medical team converted the external fixator into plate and screw internal fixation.
External Fixator Converted to Internal Fixation
Once the wound was fully healed and the swelling had subsided, the temporary external fixation system was removed. It was replaced with a custom-contoured metal plate positioned inside the limb and secured directly to the bone fragments with screws.
This internal fixation helped stabilize the fracture after the soft tissue had healed sufficiently. The staged Ortho-Plastic treatment therefore addressed both the severe soft-tissue injury and the underlying fracture as part of the patient’s recovery.
Within six weeks, the patient had started walking with partial weight-bearing support. He is now undergoing rehabilitation with the physiotherapy team.
Ortho-Plastic Approach in Complex Trauma Care
Dr. Swaminathan said that the Ortho-Plastic approach is increasingly being adopted in trauma care in India because it enables bone and soft-tissue injuries to be managed together, often during the same surgical procedure.
This coordinated approach requires orthopaedic and plastic surgeons to work closely together throughout the treatment. It is also supported by a multidisciplinary team that can include anaesthesia, critical care, infection management and other specialists as required.
By combining fracture fixation with timely soft-tissue reconstruction, the Ortho-Plastic approach can promote better wound healing, reduce complications and support faster recovery.
In complex injuries requiring microvascular reconstruction, timely treatment is particularly important, with procedures ideally performed within 72 hours of trauma. Early referral and timely transfer to a tertiary care centre with the necessary surgical expertise and multidisciplinary support are therefore essential.
Noble Hospitals Team
The medical team included Dr. Swaminathan Ravi along with Dr. Vishal Chaudhari, Head of Department of Trauma and Spine; Dr. Sangeeta Chandrashekhar, anaesthetist; Dr. Manoj Pawar, Plastic Surgeon; and Dr. Prathamesh Raut, Chief of Emergency Department, along with others.
Dr. Divij Mane, Deputy Managing Director, Noble Hospitals and Research Centre, said, “Saving a limb after a severe traumatic injury requires timely intervention, surgical expertise and close coordination between multiple specialties. I congratulate our orthopaedic and plastic surgery teams for their exemplary work in managing this complex case through a coordinated ortho-plastic approach.
“At Noble Hospitals, our focus is on ensuring faster recovery, minimising complications and helping patients regain function at the earliest, so that they can return to their work and daily lives as soon as possible.
This case is a strong example of how collaborative, multidisciplinary care can make a meaningful difference in complex trauma cases and improve the overall recovery journey of the patient.”
Also Read: Kids Clinic India Gets CCI Nod to Acquire Apollo Fertility Centre and Apollo Specialty Hospitals
