Thursday 23rd May, 2019
In any surgical procedure Plan A is important, but so is B and C, and being able to adapt and develop your treatment plan throughout the recovery process. This is especially the case in soft tissue traumatic injuries such as Pixel’s, where it is difficult to assess the full extent of the damage present at the time the first surgical procedure.
With Pixel the trauma to the extensor musculature on the outside of Pixel’s elbow was significant, but due to the short time until presentation, Plan A was to stabilise the elbow to allow us to perform primary repair of the damaged musculature. This despite the questionable vascularity of the damaged musculature.
To stabilise the elbow we placed a lateral transarticular external fixator into the humerus and radius, with the elbow held in a flexed position. This allowed the musculature to be primarily repaired.
Following surgery healing progressed of some areas, but unfortunately avascular necrosis of a large section of the extensor musculature occurred due to the damage to the vascularity at the time of injury. This led to wet-to-dry management to create a granulation bed over the remaining tissue, prior to delayed primary closure of the skin over the healthy granulation bed and surviving extensor musculature.
Fortunately, Pixel was a brilliant patient and tolerated the dressing changes really well along the way, before the external fixator was removed after 4 weeks.
After a carefully managed rehabilitation, Pixel is back to running really well and is confident to competing at National Level Canicross next season.