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#1
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06-10-2024, 06:59 PM
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Traumatic Amputation
The patient is a 41-year-old male who was involved in a motor vehicle trauma. He was the restrained driver of a truck that struck another large vehicle. The patient’s left leg was crushed inside the burning cab of the vehicle and traumatically amputated through the knee. There were some contaminated soft tissue and osseous components of the proximal tibia and knee directly within the zone of injury. A thigh tourniquet was placed in the field by the emergency responders for uncontrolled bleeding from the injured site. In the operating room, the tourniquet was removed and the injury zone explored. The popliteal artery was immediately identified and formally ligated. The remainder of the sciatic nerve was also identified and sharply transected and allowed to retract. Debridement and irrigation of the open femur fracture were performed, and a uniplanar anterior external fixator was applied. The soft tissues about the distal femur were debrided until clean margins were obtained, leaving the distal femoral condyle exposed. The soft tissues were elevated around the distal femur and closed in layers over the end of the residual limb but resulted in an irregular closure over the distal aspect of the limb with multiple areas of necrotic tissue (from the initial trauma and burn) still remaining. The patient returned to the operating room 2 days later with the plastic surgery team for superficial debridement of the distal end of the residual limb and split-thickness skin grafting from the ipsilateral thigh. |