Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table to facilitate access to the affected limb for both debridement and application of the external fixator.

Anatomical surgical approach:  A comprehensive radical debridement was performed, involving meticulous excision of all devitalized soft tissue and bone. Negative pressure wound therapy was applied to the defect site. A provisional spacer was inserted to maintain limb length, followed by the application of an Ilizarov external fixator to enable bifocal bone transport.

The surgeon noted the complexity of managing the open fracture with significant soft tissue loss and bone exposure. The use of negative pressure therapy was crucial in optimizing the wound bed for eventual closure or grafting. The Ilizarov fixator provided stable fixation while allowing for gradual bone transport to address the segmental bone defect.

Postoperative protocol:   Postoperatively, the patient was managed with regular dressing changes under negative pressure therapy. Weight-bearing was restricted initially, with gradual increase as tolerated. Physiotherapy focused on maintaining joint mobility and muscle strength.

Follow up:   Not specified.

Orthopaedic implants used:   Ilizarov external fixator, provisional spacer, negative pressure wound therapy system.