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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
Email: zengweifeng316@126.com
Case Report
Initial Presentation – Day 1
Injuries
Plan of Action
Stage I
Stage II – Day 30
Stage III – Day 40
Stage IV – Day 50
Results
Conclusion
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
malleolus
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
To Cut or not to cut.ppt.pdf (PDF, 1.64 MB)
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