Concluded Case

Debridement with tendon grafting

History of rta left dorsal of full deep abrasion for male 9 years kid with extensor tendon rupture of ehl and edl intact tibialies anteriour With bone exposed Pulsations present intact dorsaloes pedies How to proceed ?

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Concluded answer

debridement and closure done rupture tendon sutured in second procedure with tendon grafting

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1.Irrigate the wound with saline and betadine to clear away any dirt and foreign body 2.Inj Tetglob 250 units stat 3.Debridement - which should be adequate. 4.Repair of ruptured tendons with prolene sutures . 5.Plastic surgeon consultation and grafting with R.S.A flap - Immobilization of foot - post surgically

I agree with you sir.In some cases repaired with prolene I found discharging sinus where I had to remove prolene after 3 to 4 months.Iwant to know about your experience sir.
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Proper wound debridement +lavage. Sample for culture sensitivity post debridement. It would almost be impossible to close the wound post debridement,hence VAC dressing is necessary and skin grafting later. Not letting the wound getting infected should be the primary goal.

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Wound debridement and primary flap cover There may be tissue loss in tendons If cannot be brought together and sutured without tension,keep ends together with non absorbable sutures Later plan repair with graft Xray evaluation before surgery

x ray done no bony injury
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a. Debridement b. RSA flap (skin paddle with adipofascial bridge) c. If wound looks unfit after debridement, VAC 2-3 dressing can be considered followed by RSA flap reconstruction

Valuable opinion
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debride dress...debride dress....dress dress...until wound is ready for SSG

In my opinion patient should be treated by Plastic surgeon

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Repair with non absorbable sutures and graft afterwards

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Suggest to consult plastic surgeon

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Use of puraan ghruta does magic in wounds that are deep and involve musculo-skeletal tissue. If you get it then use it internally in small quantity (as it is katu rasatmak). panchatikta ghruta guggul is also a good option. As your pt is suffering from sa-vrana bhagna, it will not only help in controlling infection but also help in healing of tissues. now, to compensate for the blood loss, tapyadi loha(roupya yukta) and dashamoolarishta are excellent. Laghu santarpan is a must. Avoid potatoes, curd, brinjal. Even if plastered, regular dhupan of wound (as told in sushruta samhita) will do wonders.

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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