Challenges of limb salvage in a resource limited environment: Case report and review of literature

Cross-leg flap in a burn patient: our experience from a tertiary center from Northern Tanzania

“…Cross-leg flaps were first described in 1854 by Hamilton and are still used to salvage lower extremities in those not suitable for free tissue transfer or those in resource-limited settings [ 5 ]. Soft tissue injury can be extensive to the extent bone, tendon and blood vessels can be exposed with a risk of desiccation if early tissue coverage is not provided due to many reasons including lack of personnel [ 6 ].…”

“…There are several lower limb injury severity scoring systems to guide surgeons in deciding whether to amputate or perform limb-salvage surgeries. These scoring systems have not shown to be good predictors of limb amputation or salvage, but rather outcome depends on the surgeons’ experience and the facilities available [ 6 ].…”

“…Free flap requires expertise and microvascular reconstruction and with the prolonged surgery and high risk of failure, it was not an option in our case hence cross-leg flap was opted. Its use does impose risk of necrosis, donor site cosmetic deformity and joint stiffness due to the prolonged immobilization [ 6 ].…”

Experience with use of improvised negative pressure wound therapy in the management of wounds with exposed bone

“…These included irregular power supply and frequent breakdown of our suction machines. 7 In some cases, the pressure regulators of the machines were not functioning and the pressure used not known. Usually a negative pressure of between 75 and 125 mmHg is recommended based on the demonstrations in animal studies that blood flow peaks at 125 mmHg.…”

“…In economically constrained regions such as ours, NPWT has been fashioned with materials easily sourced at affordable cost while still achieving good results. 2,6,7 This technique is frequently used for complex wounds but, to the best of our knowledge, its effect on wounds with exposed bone has not been studied. The aim of our study is to describe the use of improvised NPWT on wounds with exposed bone, record the results and to review the literature on the subject.…”