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case_images: Left upper extremity upon arrival to Canada. Left upper extremity status upon arrival to Canada prior to undergoing first Canadian operative management demonstrating Volkmann's contracture.
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case_images: The wrist and digits were flexed demonstrating signs of a significant Volkmann's contracture (Fig. 1).
case_images: Left thigh upon arrival to Canada. Left thigh upon arrival to Canada prior to undergoing first Canadian operative management illustrating a necrotic composite graft.
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case_images: The left lower extremity wound was covered with a bolster dressing under which the necrotic composite graft was present (Fig. 2).
case_images: Left upper extremity during the initial debridement. A first urgent Canadian irrigation and debridement of the patient's left upper extremity was undertaken at the time of arrival to our institution to assess the extent of the injuries.
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case_images: Numerous significant injuries were seen (Figs. 3, 4) and are described in detail in Table 1.
case_images: Left thigh during the initial debridement. During the initial urgent Canadian irrigation and debridement, the left thigh was also debrided and assessed for the extent of injuries.
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case_images: Numerous significant injuries were seen (Figs. 3, 4) and are described in detail in Table 1.
case_images: Anterolateral thigh flap's (ALT) congested appearance. The left thigh was reconstructed using a contralateral ALT flap. The status of the flap was stable until postoperative day 6 (PID#15) when, as illustrated, the flap started to appear dusky, cold and had weakened Doppler signals.
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case_images: The postoperative course remained unremarkable up until postoperative day 6 (PID#15) when the flap appeared dusky and cold (Fig. 5) and had a weakening of Doppler signals.
case_images: Left thigh aesthetic appearance at discharge. The patient's left thigh had a good functional outcome upon discharge (PID#54) to a rehabilitation center but the aesthetic result was unsatisfactory with split-thickness skin graft coverage.
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case_images: Despite adequate functional recovery, the aesthetic result remained unacceptable (Fig. 6) and as a result, on PID#393, a final reconstructive procedure was performed to replace the split-thickness skin graft with a free transverse rectus abdominus myocutaneous flap (TRAM).
case_images: Left thigh second reconstructive attempt. The left thigh was reconstructed with a transverse rectus abdominus myocutaneous flap and the aesthetic outcome was satisfactory as shown on postoperative day 28.
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case_images: An acceptable aesthetic and functional outcome was achieved (Fig. 7).
case_images: Left thigh postoperative final appearance. The left thigh free transverse rectus abdominus myocutaneous flap's final appearance 28 days after its inset and 421 days post injury.
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