23/f got practically impaled by a bike handle while going on a morning walk. she sustained injury to her right upper lateral thigh and had profuse bleeding. the wound was packed by a surgeon and referred immediately considering the profuse bleeding and absent pedal pulses. she was hemodynamically stable, but was developing features of Acute limb ischemia like numbness,had a cold extremity, with progressively decreasing movements of the toes, with offcourse the absent pedal pulses. relevant initial evaluation was done, and duplex ultrasound suggested a injury to the common femoral artery. she was shifted to the OT immediately, considering the Golden 6 hr rule for Acute limb ischemia. on exploration of the CFA, the artery was contused, non pulsatile, and thrombosed. a thump like pulse was palpable proximal to the trauma segment, whereas no pulse in the distal segment. the injury was upto the CFA bifurcation. repair with interposition vein graft carried out successfullly with return of pulses in the foot. the badly traumatised artery can be seen. what was surprising about this injury was that it was away from the site of trauma. normally injury to the proximal SFA and SFV would have been expected in this scenario. its been 6 months since this repair, and the lady is happily mountain climbing!!
Posted on: Sun, 14 Sep 2014 14:15:12 +0000
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