Successful Microsurgical Reconstruction for Limb Salvage in a COVID-19-Positive Patient: A Case Report

• Published in: Journal of reconstructive microsurgery OPEN Vol. 6; no. 1; pp. e40 - e44
• Main Authors: Fleury, Christopher M., Chang, Brian L., Slamin, Robert P., Schwitzer, Jonathan A., Kanuri, Arjun, Masden, Derek L.
• Format: Journal Article
• Language: English
• Published: 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Thieme Medical Publishers, Inc 01-01-2021; Georg Thieme Verlag KG
• Subjects: Case Report; covid-19; limb salvage; microsurgery; COVID-19; microsurgery; limb salvage
• ISSN: 2377-0813; 2377-0821
• DOI: 10.1055/s-0041-1729955

Abstract
Background
 Although the novel 2019 coronavirus (COVID-19) pandemic delayed elective microsurgical reconstruction cases, traumatic injuries requiring microsurgical reconstruction for limb salvage still presented to our hospital. Recent data suggests a link between COVID-19 and increased venous and arterial thromboembolic events, theoretically increasing the risk of microvascular anastomotic thrombosis and flap failure.
Methods
 We provide a single case report of microsurgical limb salvage in a COVID-19-positive patient with a Gustilo IIIb open tibial-fibular fracture.
Results
 A free latissimus dorsi muscle flap was used to successfully cover a Gustilo IIIb open tibial-fibular fracture with exposed orthopedic hardware and large soft tissue defect, with 5-month follow-up demonstrating a well-healed flap allowing for preserved ambulation.
Conclusion
 Although there is a theoretical increased incidence of venous and arterial thrombotic microvascular failure in COVID-19-positive patients, microsurgical reconstruction is occasionally the lone option for salvage. Microsurgical reconstruction in this population must be carefully considered, meticulously executed, and closely monitored.