Secondary Limb-Salvage Fifty Years After Vascular Injury: A Case Report

A 73-year-old veteran presented to vascular surgery with a nonhealing left lower leg wound. Fifty years before the presentation, he sustained a gunshot wound to the left leg during combat. Emergent superficial femoral artery to popliteal artery bypass using vein graft and complex bone and soft-tissue repair resulted in successful primary limb salvage. He was entered into the Vietnam Vascular Registry at the time of his initial injury. On current presentation, he was diagnosed with infected myositis ossificans and bypass occlusion. He was originally offered wound care alone with possible amputation but elected for secondary limb-salvage after vascular surgery evaluation. He underwent serial radical debridement of his myositis ossificans and revision of the left superficial femoral artery -popliteal artery bypass with reverse great saphenous vein graft. Soft-tissue reconstruction was successful with dermal replacement followed by split-thickness skin grafting. He has continued assisted primary bypass patency with satisfactory wound healing and a functional limb.