Integrated Orthoplastic Reconstruction in Compound Limb Injuries: A 38-Year Single-Surgeon Experience in a Resource-Limited Setting

Abstract

Govindbhai Jashvantlal Purohit and Yogesh Purohit

Background: Timely vascularized soft-tissue coverage is critical in compound limb injuries to prevent infection, promote fracture healing, and reduce amputation risk. While microsurgical free tissue transfer is well established, its availability remains limited in many trauma settings. This study evaluates long-term outcomes of orthoplastic reconstruction using pedicled and fasciocutaneous flaps performed by an orthopaedic surgeon in a resource-constrained environment.

Objectives: To evaluate the safety, reliability, and functional outcomes of fasciocutaneous and pedicled flap reconstruction performed by an orthopaedic surgeon for limb soft-tissue defects.

Methods: A retrospective observational analysis of 117 patients with compound limb injuries managed over 38 years was conducted. Reconstruction combined stable skeletal fixation with regional flap coverage. Outcomes included flap survival, infection control, fracture union, limb salvage, and complications.

Results: High flap survival was achieved with low complication rates. Infection was effectively controlled in the majority of cases. Limb salvage was successful in most patients. In selected cases with small osseous defects, spontaneous fracture union occurred following vascularized coverage.

Conclusion: Pedicled and fasciocutaneous flap-based orthoplastic reconstruction provides a safe, reproducible, and cost-effective limb- salvage strategy. In appropriately trained hands, orthopaedic surgeons can independently deliver effective reconstruction in environments lacking microsurgical infrastructure.

Level of Evidence: 4

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