Tratamiento de fractura expuesta gustilo y Anderson IIIB más injerto libre de piel de abdomen

Abstract

Background: An open fracture of the upper limb is associated with deep infection, amputation, or death. The Gustilo and Anderson classification categorizes the type of fracture according to the size of the injury into grades I, II, and III; type III fractures are further sub-classified into III A, III B, and III C. Subtype B presents massive contamination, with removal of the periosteal, requiring local reconstruction with flaps.

Case presentation: A 45-year-old female patient with a grade III B Gustilo and Anderson open fracture suffered a traffic accident and received primary treatment with immobilization of the injury using a plaster orthosis and analgesic pharmacology for eight days. After initial treatment, the patient developed necrosis and compartment syndrome. Further therapeutic and corrective management was performed with surgical debridement, intravenous and local antibiotics, necrectomy, and coverage of the lesion with a free skin graft from the abdomen. Follow-up after surgery shows deformity correction and preserved mobility accompanied by radial nerve neuropraxia.

Conclusions: This case report provides information on the importance of appropriate initial management of open III B fractures, which are most prone to infection and can lead to amputation. Antibiotic prophylaxis and surgical debridement are essential in initial treatment; subsequent reconstruction using a free skin graft from the abdomen has proven an effective technique, significantly improving the long-term prognosis both aesthetically and functionally.