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Kumar. Plast Aesthet Res 2020;7:27 I http://dx.doi.org/10.20517/2347-9264.2020.07 Page 5 of 6

A B

C D

Figure 3. Photographs of case 3 showing: A: post-traumatic defect over knee; B: limited access dressing applied over the wound (see text
for detail); C: 20 days post-limited access dressing result; D: result after 3 months

with a better and less bulky aesthetic result. At centers with microsurgical capabilities, free flap surgery
can be expected to provide a better cosmetic result in a shorter time. But in the absence of such facilities
and expertise, LAD is more reliable and a better alternative for a better aesthetic result. Also, the patient
required physiotherapy in the post-operative period. There was minimal wound contracture after 6 months
and no corrective surgery was required.

Case 2
[4]
In this case, ultraconservative debridement under LAD avoided further tissue loss and intermittent
negative pressure with moist healing promoted granulation tissue formation over the wound bed and
exposed tendon. Generally, skin flaps from the remaining half of the circumference of the affected limb may
cause damage to the remaining lymphatics and result in intractable lymphedema. Successful resurfacing
with SSG provided an acceptable result without distal edema and limb contracture.

Case 3
Common flaps available for coverage of the exposed patella and patellar tendon are the medial
[9]
gastronemius, extended myocutaneous or fasciocutaneous flap . All these flaps cause significant donor
site defects, which could easily be avoided by using LAD. In the present case, the reconstruction result was
not bulky and did not have any donor defect or distal edema. The exposed patella and patellar tendon were
covered by granulation tissue under the moist environment of LAD. Approximating sutures were applied to
bring the skin edges together and the gap in between epithelialized.

The above cases suggest that LAD may be a useful tool in achieving a higher level of aesthetic outcomes
in the resurfacing of extensive or difficult to treat wounds by avoiding bulky flaps, significant donor site
defects, and distal edema due to compromised drainage from harvesting large regional flaps.

DECLARATIONS

Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.