J Korean Soc Traumatol.  2016 Dec;29(4):204-208. 10.20408/jti.2016.29.4.204.

Concise Bedside Surgical Management of Profound Reperfusion Injury after Vascular Reconstruction in Severe Trauma Patient: Case Report

• Chung HJ
• Kim SY
• Byun CS
• Kwon KY
• Jung PY

• KMID: 2378461
• DOI: http://doi.org/10.20408/jti.2016.29.4.204

Abstract

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

Keyword

Reperfusion injury; Closed injury; Femoral artery; Vascular reconstruction; Hip disarticulation

MeSH Terms

Adult
Aircraft
Amputation
Bays
Blood Gas Analysis
Constriction
Decision Making
Emergency Service, Hospital
Extremities
Femoral Artery
Hemothorax
Humans
Hydrogen-Ion Concentration
Ligation
Lower Extremity
Male
Reperfusion Injury*
Reperfusion*
Rib Fractures
Rupture
Shock
Survival Rate
Trauma Centers
Veins
Vital Signs