Coordinated Ortho-Plastic Approach Helps 60-Year-Old Accident Patient on Road to Recovery
Pune 5 October 2026: A two stage Ortho-Plastic procedure on a 60-year-old man helps save his limb post a traumatic accident. The procedure was led by Dr. Swaminathan Ravi, Plastic and Reconstructive Surgeon at Noble Hospitals and Research Centre.
The patient riding a two-wheeler had met with an accident after it was hit by a truck on Shikrapur road. The tyre went over his leg resulting in compound fracture, vascular injury and severe soft tissue loss / skin loss and muscle loss.
Dr. Swaminathan Ravi, Plastic and Reconstructive Surgeon at Noble Hospitals said that we went with a combined ortho-plastic approach which includes two stages.
The first stage included Thorough Debridement . This involves a carefully planned, three-step approach to manage the severe wound and unstable fracture. First, the surgical team thoroughly cleaned the wound and removed dead, damaged and contaminated tissue, along with any loose bone fragments that could increase the risk of infection. The fracture was then stabilized using an external fixation device, in which pins are placed into healthy bone and connected to a frame outside the body. This keeps the bone properly aligned while allowing doctors to access and treat the wound. Finally, Vacuum-Assisted Closure (VAC) therapy, also known as Negative Pressure Wound Therapy, was applied using a special foam dressing connected to a controlled suction system. The therapy helps remove excess fluid from the wound, supports the formation of healthy tissue and creates a better environment for healing.
The second stage procedure was done within next 72 hours which is known as microvascular free flap. A microvascular free flap is an advanced reconstructive surgery used to repair large and complex wounds. In this procedure, healthy tissue such as skin, muscle, fat or bone is taken from another part of the patient’s body and carefully transferred to the injured area. The tiny blood vessels of the transferred tissue are then connected to blood vessels at the wound site using a surgical microscope, allowing the tissue to receive a fresh blood supply and survive. In this case a huge tissue of almost 30 cm x18cm was transferred from the right thigh to the wounded left leg.
Dr. Vishal Chaudhari, Head of Department of Trauma and Spine, at Noble Hospitals and Research Centre said that this procedure can be particularly important after severe trauma, when a large amount of damaged tissue has been removed and bone or surgical hardware is exposed. The free flap provides healthy, well-blooded tissue to cover the exposed area, fill large defects and create better conditions for healing. It can also help reduce the risk of persistent infection in severely damaged wounds and support efforts to save the affected limb.
Dr. Chaudhari , added that once the wound healed in about four weeks, we converted the external fixator into plate and screw (Internal Fixation).
Plate and Screw (Once the wound is fully healed and the swelling is gone, the temporary outside scaffold is removed. It is replaced by a custom-contoured metal plate tucked deep inside your limb, screwed directly into the bone fragments to lock them permanently into place)
In six weeks, the patient has started walking with partial weight bearing support. He is now working on rehabilitation with the physiotherapy team.
Dr. Swaminathan said that the ortho-plastic approach is increasingly being adopted in trauma care in India because it enables bone and soft-tissue injuries to be managed together, often during the same surgical procedure. This coordinated approach requires the orthopaedic and plastic surgeons to work closely together throughout the treatment, supported by a multidisciplinary team including anaesthesia, critical care, infection management and other specialists as required. By combining fracture fixation with timely soft-tissue reconstruction, it can promote better wound healing, reduce complications and support faster recovery. In complex injuries requiring microvascular reconstruction, timely treatment is particularly important, with procedures ideally performed within 72 hours of trauma. Early referral and timely transfer to a tertiary care centre with the necessary surgical expertise and multidisciplinary support are therefore essential.
The team included Dr. Swaminathan Ravi along with Dr. Vishal Chaudhari, Head of Department of Trauma and Spine, Dr. Sangeeta Chandrashekhar, anaesthetist, Dr.Manoj Pawar, Plastic Surgeon, Dr.Prathamesh Raut Chief of Emergency Department along with others.
Dr. Divij Mane, Deputy Managing Director, Noble Hospitals and Research Centre said that saving a limb after a severe traumatic injury requires timely intervention, surgical expertise and close coordination between multiple specialties. I congratulate our orthopaedic and plastic surgery teams for their exemplary work in managing this complex case through a coordinated ortho-plastic approach. At Noble Hospitals, our focus is on ensuring faster recovery, minimising complications and helping patients regain function at the earliest, so that they can return to their work and daily lives as soon as possible. This case is a strong example of how collaborative, multidisciplinary care can make a meaningful difference in complex trauma cases and improve the overall recovery journey of the patient.
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