Male patient V.M.D (44 years old, ethnic minority, residing in Tuyen Quang) was transferred to the National Hospital for Tropical Diseases in a state of serious injury to his left calf after a month of self-treating burns at home.
According to the patient, about a month before being hospitalized, he suffered from fire burns but did not go to a medical facility but treated himself by applying leaves according to folk experience. Only when the burn area was swollen, pain gradually increased, odor appeared, pus discharged and necrosis spread, was the patient taken to a provincial hospital, then transferred to a central hospital for treatment.
Dr. Duong Manh Chien - in charge of the Department of Plastic Surgery and Interdisciplinary Surgery, Central Tropical Diseases Hospital - said that upon admission, the entire back of the patient's left calf was almost completely necrotic.
The lesion area spreads to about 50-70% of the foot, deeply destroying the heel bone, heel tendon (achilles tendon) and the tips of the tibia and fibula. The wound smells bad, many tissues are necrotic and the risk of widespread infection is very high" - Dr. Chien said.
Immediately after that, the team of doctors proceeded to remove the entire black humus necrotic tissue and placed a negative pressure aspiration system (VAC) to control the infection. After a week of intensive care, the necrotic condition was controlled, creating conditions to enter the stage of restoration of the damaged area - a major challenge due to the very large area of deficiency, accompanied by osteoarthritis and exposed bone.
During the major surgery lasting about 6 hours, plastic surgery specialists in coordination with orthopedic trauma performed a thorough scraping of inflammatory tissue and necrotic tissue in the bone, then performed complex microsurgery techniques to regenerate the injured area.
Doctors chose to take a muscle patch from the patient's own back to cover the missing area. The muscle part of the graft helps provide a rich blood source, delivering antibiotics and immune cells to control osteomyosis, while the skin part helps regenerate a sturdy heel pad for later walking.
According to Dr. Duong Manh Chien, the biggest difficulty of the surgery was reconnecting the blood vessel supplying the graft to the vascular system in the calf area that was severely damaged due to infection. Doctors had to perform end-to-side vascular reconnection techniques to ensure blood supplying the graft while maintaining blood flow down to nourish the foot.
This is a severe surgery with many risks due to the large area of damage, high bleeding risk and prolonged surgery time. The patient had to be anesthetized in a prone position - a position with more risks than conventional surgeries," said Dr. Chien.
Two days after surgery, the patient's graft was initially stable. However, the patient still needs to be monitored for a long time to completely control infection and restore motor function.
Dr. Duong Manh Chien recommends that arbitrarily applying leaves, using medicine of unknown origin or delayed access to medical facilities can cause severe infection of the wound, even destroy tendons and bones if not treated promptly. This increases the risk of limb loss, even threatening the patient's life.
