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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can the leg be saved? Gunshot injury to lower limb

i would like to know if we can safe his leg .. this is a medical report : Gunshot injury lower limb . Left popliteal-tibial artery and venous injury. Synthetic popliteal-tibial artery bypass graft, fasciotomy, venous ligation. Failed revascularization 3 times due to thrombosis , soft tissue at the medical side of left leg. Crush injury left leg with neurovascular injury. History: 23 year old Saudi male of alleged gunshot injury ant RTA on 09/09/12 with above mentioned injuries and procedures. Operative procedures done: 1 first surgery- reconstruction of left popliteal and post tibial artery with saphenous vein graft. 2 2nd surgery on 11/09/2012 re-exploration for thrombectomy of graft and redo popliteal post tibial artery bypass left side. 3 day 3 again patient underwent re-exploration for thrombosed graft and redo popliteal to post tibial artery bypass using synthetic graft- debridement of necrotic muscles, fasciotomy. Plastic team covering the graft by soft tissue ( non-viable muscles) . In view of recurrent thrombosis possibility of distal micro vascular bed thrombi and patent need angiogram and catheter directed thrombolic therapy. On examination the patient is conscious and oriented and V/S stable. Left lower limb examination: Diffuse swelling of lower limb including foot. Multiple skin blisters left foot / ankle Bluish, swollen toes of left foot Absent sensation, absent toe, ankle, knee movement Foot drop position of foot left Sutured operative wound medical aspect of left thigh. Large wound extending from knee down to ankle over medical aspect of left leg with smelly devitalized muscles in the most part. Anterior and lateral compartment fasciotomy wound shows black to brown discolored devitalized muscles. Good Doppler signals dorsalis pedis and posterior tibial artery with O2 saturation in of 96% in left foot toes. P PULSES RIGHT FEM +2 POP +2 DP +2 PT +2 LEFT FEM +2 POP +2 DP 0 PT 1 triphastic Doppler signal) Ct angiogram Patient popliteal artery synthetic bypass graft with perigraft fluid Devitalized muscles posterior compartment covering the graft Fracture left fibula proximal end
Mon, 8 Oct 2012
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Orthopaedic Surgeon 's  Response
Hello.
Thanks for writing to us.
Since the blood vessels are injured, a clinical assessment is needed to know if the leg can be saved or not. If the tissue shows redness then blood supply is intact in the area and can be saved.
I hope this information has been both informative and helpful for you.
Regards,
Dr. Praveen Tayal
drtayal72@gmail.com
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