Vipin and leg
I was working in fortis gurgaon and metro hospital faridabad. Month of august is usually busy month. Traumatic injuries peak this time. On 12/8/16 i received a call from Dr Harish a orthopaedic surgeon who was working in metro hospital that point of time.It was around 9.30 pm and he talked about popliteal artery injury which was present along with fracture supracondylar femur. CT angio has been done which showed popliteal artery injury.
Vipin was a office worker residing in fatehpur baloch. who use to work in faridabad . On the fateful day he was coming home from office his motorcycle met with with a accident with tempo. Tempo are three wheeler commercial vehicles who transport goods . He was brought to metro hospital faridabad around 6 pm and was admitted. He was diagnosed to have fracture femur and subjected to radiological studies which revealed the the fracture, However vascular injury was missed in initial survey. Patient was shifted to SICU where excessive non responsive to opiate analgesics , led to a vigilant Dr Javed to investigate the real cause of patients misery. lower limb was cold and no pulses were palpable ,he ordered color doppler to investigate. Doppler confirmed his worst fears ,no flow in all lower leg arteries, he informed orthopedic surgeon decision to do CT angio was taken. CT angio showed total transection of popliteal artery at the site of injury, significance of severity of injury dawned on treating doctors. Hurriedly decision to expedite surgery and to call vascular surgeon was made. Dr Harish called me and apprised me of situation and plan for emergency surgery.
I immediately got ready for surgery checked my instruments and left for hospital, I met patient in surgical ICU and Dr Javed.I was briefed about injury by Javed. After seeing the patient and CT angio I informed OT and Dr Harish about surgical plan .Ortho team needed to put external fixator that was ordered and needed to be autoclaved . Popliteal artery injury holds special place in emergency vascular surgery, since injury to popliteal artery invariably leads to amputation. Even failure of surgical repair results in amputation. Explaining these things to patients attendants in middle of the night can be a daunting task, nevertheless I just did it . Mercifully they accepted it , were positive in their response , perhaps by lack of choice.
Surgery was started around midnight ,first fasciotomy was done to confirm muscle viability, then ortho team put a external fixator and around 4 am I was called I immediately harvested a contralateral long saphenous vein graft .Injury site was explored and damaged artery was exposed and trimmed to remove damaged artery. Fasciotomy wound was used to expose posterior tibial artery near ankle and fogarty catheter no3 was used to clear out thrombus after arteriotomy. Saphenous vein graft was reversed and anastomosed to popliteal artery in end to side fashion. After checking patency of anastomosis and ensuring blood flow in vein graft , I connected vein grafted to posterior tibial artery. Leg started bleeding immediately and foot pinked up. It was 6.30 am in morning , we spend next half hour getting through hemostasis to control bleeding. Anaesthesist was Dr Manoj Gupta who managed it deftly.
Around 7.30 am patient was shifted to SICU , I briefed team members of SICU about post operative management and left hospital. Pulse oximetry was attached to patients toes and regular monitoring was done , urine output was monitored hourly.Patient gradually improved and blood was given to replace loss. After one week of surgery when we were deciding to shift to general ward his creatinine begin to rise renal failure was diagnosed and family was informed, nephrologist was roped in for management.Dr Chauhan our nephrologist was man of positive spirit ,he was very supportive and proactive in management of patient. Patient need these things in these testing times ,little hope is thread needed to transverse turbulent waters of life. Gradually renal function improved , but wound become little infected and culture sensitivity showed hospital acquired infection sensitive to renal toxic antibiotics. I decided after almost month after injury to discharge patient , it was tough to explain but I was firm. I depute one dresser for wound management and told them to visit only once a week to hospital.
Gradually wound improved his general condition improved and after two months I did skin grafting of fasciotomy wounds and achieved wound closure. Microvascular surgery is a good tool to solve difficult problems, save limbs and salvage career .
After one month of skin grafting he underwent ORIF for femur fracture ,in presence of extensive comminution of it is slowly healing,80% healing is achieved.
Now after almost one year Vipin is walking on its legs and slowly rehabilitating himself in society.
Dr Adhishwar Sharma +91 8860650846
Vipin was a office worker residing in fatehpur baloch. who use to work in faridabad . On the fateful day he was coming home from office his motorcycle met with with a accident with tempo. Tempo are three wheeler commercial vehicles who transport goods . He was brought to metro hospital faridabad around 6 pm and was admitted. He was diagnosed to have fracture femur and subjected to radiological studies which revealed the the fracture, However vascular injury was missed in initial survey. Patient was shifted to SICU where excessive non responsive to opiate analgesics , led to a vigilant Dr Javed to investigate the real cause of patients misery. lower limb was cold and no pulses were palpable ,he ordered color doppler to investigate. Doppler confirmed his worst fears ,no flow in all lower leg arteries, he informed orthopedic surgeon decision to do CT angio was taken. CT angio showed total transection of popliteal artery at the site of injury, significance of severity of injury dawned on treating doctors. Hurriedly decision to expedite surgery and to call vascular surgeon was made. Dr Harish called me and apprised me of situation and plan for emergency surgery.
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| vein graft from popliteal artery to post tibial |
I immediately got ready for surgery checked my instruments and left for hospital, I met patient in surgical ICU and Dr Javed.I was briefed about injury by Javed. After seeing the patient and CT angio I informed OT and Dr Harish about surgical plan .Ortho team needed to put external fixator that was ordered and needed to be autoclaved . Popliteal artery injury holds special place in emergency vascular surgery, since injury to popliteal artery invariably leads to amputation. Even failure of surgical repair results in amputation. Explaining these things to patients attendants in middle of the night can be a daunting task, nevertheless I just did it . Mercifully they accepted it , were positive in their response , perhaps by lack of choice.
Surgery was started around midnight ,first fasciotomy was done to confirm muscle viability, then ortho team put a external fixator and around 4 am I was called I immediately harvested a contralateral long saphenous vein graft .Injury site was explored and damaged artery was exposed and trimmed to remove damaged artery. Fasciotomy wound was used to expose posterior tibial artery near ankle and fogarty catheter no3 was used to clear out thrombus after arteriotomy. Saphenous vein graft was reversed and anastomosed to popliteal artery in end to side fashion. After checking patency of anastomosis and ensuring blood flow in vein graft , I connected vein grafted to posterior tibial artery. Leg started bleeding immediately and foot pinked up. It was 6.30 am in morning , we spend next half hour getting through hemostasis to control bleeding. Anaesthesist was Dr Manoj Gupta who managed it deftly.
Around 7.30 am patient was shifted to SICU , I briefed team members of SICU about post operative management and left hospital. Pulse oximetry was attached to patients toes and regular monitoring was done , urine output was monitored hourly.Patient gradually improved and blood was given to replace loss. After one week of surgery when we were deciding to shift to general ward his creatinine begin to rise renal failure was diagnosed and family was informed, nephrologist was roped in for management.Dr Chauhan our nephrologist was man of positive spirit ,he was very supportive and proactive in management of patient. Patient need these things in these testing times ,little hope is thread needed to transverse turbulent waters of life. Gradually renal function improved , but wound become little infected and culture sensitivity showed hospital acquired infection sensitive to renal toxic antibiotics. I decided after almost month after injury to discharge patient , it was tough to explain but I was firm. I depute one dresser for wound management and told them to visit only once a week to hospital.
Gradually wound improved his general condition improved and after two months I did skin grafting of fasciotomy wounds and achieved wound closure. Microvascular surgery is a good tool to solve difficult problems, save limbs and salvage career .
After one month of skin grafting he underwent ORIF for femur fracture ,in presence of extensive comminution of it is slowly healing,80% healing is achieved.
Now after almost one year Vipin is walking on its legs and slowly rehabilitating himself in society.
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