Abstract
Relevance. Discussion of the criteria for decision making “amputation vs. preservation”, when viability of the extremity is uncertain, has been continuing. The case description. The lower extremity of a serviceman was injured by a caterpillar tractor. The severity of the damage was determined by the following conditions: open segmental fracture of the femoral diaphysis, 5 cm traction-compression damage of the popliteal artery, acute thrombosis of the popliteal and tibial arteries, sciatic nerve damage, circular detachment of the thigh skin, acute hemorrhage, II degree shock, and uncompensated lower extremity ischemia throughout 24 hours. The MESS score of the injured extremity was 8 indicating that an amputation would have been considered. Nevertheless, we choose the organ preservation solution with the revascularization of the injured limb segment. A multi-stage treatment was carried out including stabilization of bone fragments, primary reconstruction of the popliteal artery to restore the arterial blood flow in the injured extremity, reperfusion injury and myoglobinuria elimination, intensive kidney protection therapy, infection management, skin defects replacement, orthopedic surgery. As a result of the treatment, the injured limb was saved. The femur fracture healed allowing the patient to walk without assistance. Conclusion. The use of the programmed surgical treatment for severe mechanical injury of the lower extremity, an individual multi disciplinary approach, assessing the severity of systemic disorders, and timely use of extracorporeal detoxification made it possible to avoid amputation, perform organ preservation surgery, and create favorable conditions for restoring the supporting function of the lower extremity.
Highlights
Оказание помощи пострадавшим с тяжелой травмой конечностей, сопровождающейся повреждением магистральных сосудов, является серьезной проблемой, поскольку связано с трудностью диагностики, прогнозирования исхода и, соответственно, сложностью определения оптимальной лечебной тактики [1, 2, 3]
The lower extremity of a serviceman was injured by a caterpillar tractor
The severity of the damage was determined by the following conditions
Summary
Оказание помощи пострадавшим с тяжелой травмой конечностей, сопровождающейся повреждением магистральных сосудов, является серьезной проблемой, поскольку связано с трудностью диагностики, прогнозирования исхода и, соответственно, сложностью определения оптимальной лечебной тактики [1, 2, 3]. Важным моментом при принятии решения о сохранении конечности или ампутации является опыт хирургов, а также диагностические и лечебные возможности медицинского учреждения. Важным условием для принятия решения о сохранении конечности в условиях длительной некомпенсированной ишемии является готовность к развитию осложнений в виде реперфузионного и мионефропатического синдромов, острого 2020;26(1)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
