Title: Salvaging a Crush Avulsed Ischemic Upper Limb with Complete Radial and Ulnar Artery Transection at a Peripheral Medical Setup: Case Report

Author: Dr. A. P. Chitragupta MD

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i1.08

Abstract

With expanding means of transportation, and increase in outdoor and adventure motorsports activities, there has been a surge in the number of road traffic accidents and associated fatalities. The associated mortality and loss of appendages are emerging as a major public health concerns. Recent advances in surgical repair procedures and reconstruction techniques have facilitated more and more life and limb salvaging surgeries. The Mangled Extremity Severity Score (MESS) remains the most used scoring system; however it has not been validated for mangled injuries of upper extremities. Performing a temporary intravascular shunting in an attempt to salvage a precious upper limb, at a peripherally located medical setup is challenging. We present a case of severely injured left upper forearm with associated ischemia due to severed radial and ulnar artery, successfully salvaged at a sub optimally equipped peripherally located medical setup in highly uncongenial terrains of north east part of India.

Keywords: Road Traffic Accidents, MESS, Upper Extremities,  Limb Salvage, Temporary Intra vascular shunting, uncongenial terrain.

References

1.      Chen ZW. Progress in limb and digital replantation: Part A–Introduction. World J Surg. 1990;14(6):804–806.

2.      Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24(8): 742–6.

3.      Johansen K, Daines M, Howey T “et al”. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 1990;30: 568–72.

4.      Togawa S, Yamami N, Nakayama H, Mano Y, Ikegami K, Ozeki S. The validity of the mangled extremity severity score in the assessment of upper limb injuries. J Bone Joint Surg Br. 2005;87(11):1516–1519.

5.      Prichayudh S, Verananvattna A, Sriussad-aporn S, Sriussadaporn S, Kritayakirana K, Pak-art R. Management of upper extremity vascular injury: outcome related to the Mangled Extremity Severity Score. World J Surg.2009;33(4):857–863.

6.      O'Donnell BD, Ryan H, O'Sullivan O, Iohom G.Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, random-ized, controlled trial. Anesth Analg 2009;109:279-83.

Corresponding Author

Dr. A. P. Chitragupta MD

Department of Anaesthesiology & Critical Care,

Military Hospital Bikaner, Rajasthan India Pin 334001

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