Natural disasters, such as hurricanes and severe flooding, pose a threat of increased skin and soft-tissue infections, especially in the event of open fractures and wading through the waters. The purpose of this case study is to present a complex patient sustaining trauma resulting in an open bimalleolar fracture, multiple wounds, and exposure to a variety of water-borne pathogens during Hurricane Harvey in Houston, Texas, in 2017. He underwent multiple incision and drainage procedures, tissue cultures, and placement of antibiotic beads, with an application of external fixation to the left ankle. Several unique multidrug-resistant water-borne pathogens were identified, including Aeromonas hydrophila, Pseudomonas fluorescens/putida, and Serratia marcescens. Once the soft-tissue envelope was restored and infection cleared, a full-thickness rotational flap with tissue expansion was performed. Ultimate reconstruction was delayed several weeks and final left ankle open reduction and internal fixation was performed following antimicrobial treatment with split-thickness skin autograft and wound vacuum-assisted closure application. The patient was discharged after 28 days with no further complications. In instances such as these, all caretakers coming into contact with the patient should be aware of the potential risks of the possible infectious diseases and management to optimize the recovery following hydrologic disasters.

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