# Lower limb salvage in necrotizing burn wound infection: The role of fibular ostectomy and local flaps in a resource-limited setting – A case report and literature review

## TL;DR

This paper presents a case of a rare necrotizing burn wound infection managed successfully in a resource-limited setting using a novel reconstructive technique.

## Contribution

The paper introduces a practical limb preservation strategy using fibular ostectomy and local flaps in the absence of microvascular surgery.

## Key findings

- A 26-year-old patient's limb was preserved using proximal fibular ostectomy and a bipedicled local advancement flap.
- The technique allowed successful reconstruction despite limited surgical resources.
- The case highlights the feasibility of simple reconstructive methods in managing severe burn infections.

## Abstract

Necrotizing burn wound infections following burn injuries are rare. Literature on these cases is also scarce. These infections are life- and limb- threatening unless properly managed. They also pose significant reconstructive challenge, especially in settings lacking microvascular capability. This report describes a limb preservation strategy for limb-threatening necrotizing infection of the leg that complicated a burn injury. Innovative approach was used, utilizing proximal fibular ostectomy, bipedicled local advancement flap and split thickness skin graft.

A 26-year-old female patient presented to our burn unit after sustaining a contact burn injury from a burning charcoal to her right lateral leg within three days. On the second day of admission, the patient developed significant changes in the appearance of the wound, leading to the diagnosis of necrotizing myofacitis. Emergent debridements were done with the aim of preserving the limb. Subsequent successful, albeit sub-optimal, reconstruction was also achieved despite the lack of microvascular surgical capability in the burn unit.

This case report and literature review describes a rare limb-threatening necrotizing burn wound infection. The significant reconstructive challenge posed by the defect was addressed using a simple but rarely described reconstructive technique. The importance of limb preservation in LMIC is also emphasized.

The goal of preserving a limb can be met by using a simple reconstructive technique, despite the lack of microvascular capabilities.

•This report describes a rare limb- threatening necrotizing burn wound infection managed in a resource limited setting.•The report presents utilization of proximal fibular ostectomy and local flap for lower limb preservation.

This report describes a rare limb- threatening necrotizing burn wound infection managed in a resource limited setting.

The report presents utilization of proximal fibular ostectomy and local flap for lower limb preservation.