Circumstances of Injury:

On October 23, 2023, Oleg was performing a combat mission to defend Ukraine by evacuating wounded comrades from the battlefield. During the evacuation, the enemy deployed an anti-personnel mine that exploded directly under Oleg’s feet, causing him severe injuries.

Despite the pain and trauma, Oleg remained conscious. He applied a tourniquet to himself and continued his mission to save his comrades.

Diagnosis:

• Condition following multiple explosive trauma (October 27, 2023).
• Gunshot fracture of the upper third of the tibia and fibula shafts, with bone tissue loss.
• Status post multiple wound debridements, Ilizarov external fixation device applied to the left lower leg, defect temporarily filled with a cement spacer, and soft tissue defect reconstructed with a vascularized gastrocnemius muscle flap (VADF). Medical Details:

  Multiple Explosive Trauma (MET):

  • Combined injuries caused by an explosive blast and shrapnel, resulting in damage to bones, soft tissues, blood vessels, and nerves.

  Open Gunshot Fracture of the Upper Third of the Tibia and Fibula:

  • A comminuted fracture with significant bone tissue loss.
  • High risk of infection due to the open nature of the injury.

  Post-Surgical Interventions:

  • Ilizarov Apparatus: Provides external stabilization of the fracture and stimulates bone regeneration.
  • Cement Spacer: A temporary solution to fill the bone defect and prevent infection.
  • Soft Tissue Reconstruction: A vascularized flap from the lateral head of the gastrocnemius muscle ensures adequate blood supply to the injured area, promoting healing.

Clinical Plan:

1. Osteosynthesis of the Tibia:

• Surgical stabilization of bone fragments to restore anatomical alignment and ensure stability.
• Performed using metal implants such as plates, screws, or an intramedullary nail.

2. Replacement of Bone Defect with Bioactive Glass:

• Bioactive glass (e.g., Bonalive) will be used to fill the bone defect.
• Bioactive glass stimulates bone regeneration, integrates with natural bone, and gradually resorbs, leaving behind healthy, new bone tissue.