To Cut or not to cut.ppt .pdf

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Original filename: To Cut or not to cut.ppt.pdf
Title: To Cut or not to cut:: The surgical decision-making for limb salvaging
Author: Gavish

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To Cut or not to cut:
The surgical decisionmaking for limb salvaging
WeiFeng Zeng, ZhiHong Tong
Hand and Foot Microsurgery ,The Second Hospital of Dalian
Medical University, China

Case Report
Initial Presentation – Day 1
Plan of Action
Stage I
Stage II – Day 30
Stage III – Day 40
Stage IV – Day 50

Initial Presentation
 March 2014 – Motorvehicular Accident
 Healthy 23 year old male
 2 legs crushed by the truck
 Brought to the ER within 1 hour
 Vitals Unstable
 Hypovolemic Shock
 Tachypnea
 Consequent Blood Loss

 Multiple ribs fracture
 Pulmonary contusion

 AND ALSO……..

Injuries –
Right Leg
 Avulsion from the thigh to the ankle
 Skin degloving of the right ankle and hind foot
 Anterior and posterior tibial neurovascular bundle trauma
 Right ankle dislocation
 Lacerated dorsalis pedis
 Fracture of the tibia
 Fracture of the fibula

Injuries –
Left Leg
 Crushed flat
 Extensive soft tissue damage
 Multiple joint dislocation
 Exposed plantar tendons
 Degloving injury to the lateral, medial and dorsal
 Metatarsal dislocation
 Avascular big toe

Plan of Action
 4-Staged Intervention
 Stage I
 Emergency Intervention

 Stage II
 Debridement

 Stage III
 Free Flap

 Stage IV
 Mesh Skin Grafting
 Micro Skin Grafting

Stage I: Emergency Intervention
 Patient refuse amputation
 Hemostasis
 Correction of Shock
 Packed Cell Volumes, Colloids

K-Wire Fixation
Left 2nd toe amputated
Packed Gauze Dressing
Sent to ICU Post-Op

Stage II: Debridement
 4 sessions of Debridement within 1 month
 Prepare for Free Flap
 Assess Healing Process
 No Rehabilitation Started

Stage III: Anterolateral Thigh Flap (ALTF)
 Left foot and ankle defect of 26cm x 19cm
 26cm x 18cm anterolateral thigh flap
 Abdominal skin grafting
 Malleolus left untouched for now

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