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Tue Aug 8 12:08:41 BST 2006

 I think the stenting was an interesting idea--after all, this is not definitive we all agree, the graft can only be a temporizing measure, and this maneuver extends the temporizing--it will not last tho as long as it is exposed.  The need for amputation must only depend on the viability and function of the leg, and if that is intact you should continue your attempts at salvage.  There does not appear to be any threat to life here, unless you are talking about the bleed.  One thing that may buy time until the leg is ready for a definitive reconstruction I mentioned before--cover with a xenograft--pigskin--this will act very much like a full thickness coverage and protect the suture lines.
ERF

-----Original Message-----
From: Rgross at harthosp.org
To: trauma-list at trauma.org
Sent: Tue, 8 Aug 2006 6:54 AM
Subject: Re: SGW to Femoral triangle - Synthetic vs "autogenous"

Sorry to say this Ken, but I think it is time to cut your loses (no pun
intended), and look to amputation.  The expression "life over limb"
comes to mind, and I have thought all along, from what you described,
that the limb in question was going to be lost, I just wasn't sure
when.
Ron
>>> <KMATTOX at aol.com> 8/7/2006 11:18 AM >>>
On the cases I presented last week, one developed an arterial sentinel 

bleeding episode during dressing change, which became torential the
next  day.   
Arteriogram revealed a site at the proximal suture line,  STENTED with

endovascular stent which stopped the bleeding.  TWO days later  the
same thing happened 
to the distal suture line and again a stent stopped the  bleeding.  NO

further bleeding, but groin is still a mess and not ready for  an extra
anatomic 
bypass.  

What can we expect???
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SGW to Femoral triangle - Synthetic vs "autogenous"