case_images: PMC4959408_01
case_images: Preoperative picture before debridement
case_images: JSTCR-7-23-g001.jpg
case_images: PMC4959408_01_JSTCR-7-23-g001.jpg
case_images: F1
case_images: The first patient was attacked by armed robber; he sustained Gustilo 3B open fractures with two soft tissue defects: A lateral one measuring 12 cm x 7 cm and a medial defect 14 cm x 6 cm [Figure 1] with injury to the recurrent sural artery precluding the use of the reversed sural artery flap for wound coverage.
case_images: Immediate postoperative picture
case_images: JSTCR-7-23-g002.jpg
case_images: PMC4959408_01_JSTCR-7-23-g002.jpg
case_images: F2
case_images: He subsequently had wound coverage with two perforator-based propeller flaps raised from the medial and lateral aspect of the leg [Figure 2].
case_images: Follow-up picture 6 weeks postoperatively
case_images: JSTCR-7-23-g003.jpg
case_images: PMC4959408_01_JSTCR-7-23-g003.jpg
case_images: F3
case_images: Figure 3 shows the surgical outcome six weeks postoperatively.
case_images: Preoperative picture showing exposed Achilles tendon. The cavitation effect of the gunshot damaged the sural artery
case_images: JSTCR-7-23-g004.jpg
case_images: PMC4959408_01_JSTCR-7-23-g004.jpg
case_images: F4
case_images: The sural artery was found severed in the wound [Figure 4].
case_images: Immediate postoperative picture
case_images: JSTCR-7-23-g005.jpg
case_images: PMC4959408_01_JSTCR-7-23-g005.jpg
case_images: F5
case_images: A perforator-based propeller flap was raised to cover the wound and split thickness skin graft was applied to the secondary defect [Figure 5].
case_images: Fifth postoperative day
case_images: JSTCR-7-23-g006.jpg
case_images: PMC4959408_01_JSTCR-7-23-g006.jpg
case_images: F6
case_images: Flap survived without any area of loss [Figure 6].
case_images: Preoperative planning showing the flap outline. Identified perforators were marked as x on the outline
case_images: JSTCR-7-23-g007.jpg
case_images: PMC4959408_01_JSTCR-7-23-g007.jpg
case_images: F7
case_images: Perforators in the proposed donor tissue close to the defect were located preoperatively using handheld Doppler (probe) and marked on the skin using methylene blue [Figure 7].