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Tue Aug 8 23:38:41 BST 2006

I agree with this and am very sensitive about removing a doomed limb at the earliest time, but right now we are just days, not weeks and months, into it, and there is really no indication of inevitable doom just yet.  The LEAP study published in several installments in the NEJM has clearly shown that some of the old maxims guiding the need for early amputation have fallen by the wayside as data drives by--i.e. loss of plantar sensation, Gustilo III-C injuries, severe venous insufficiency, etc etc have all shown surprisingly good salvage of reasonably functional limbs with present technology.  In view of the patient's wishes to continue, and no overriding reason to amputate at present, I think it is reasonable to give the wounds a chance to heal and attempt an extra-anatomic bypass within a few days if at all feasible.
ERF 

-----Original Message-----
From: rgross at harthosp.org
To: trauma-list at trauma.org
Sent: Tue, 8 Aug 2006 3:50 PM
Subject: Re: SGW to Femoral triangle - Synthetic vs "autogenous"

Ken,
While the leg might be viable, is it or might it still be FUNCTIONAL. 
As I try to envision the destruction to the groin and upper thigh as
described, a wonder if there will be any FUNCTION or if he will instead
be dragging a viable, non-functional appendage, much as a sailboat would
drag her anchor in a storm.......
My guess is, knowing Dr. Mattox, that the leg will not be functional,
and the debate now raging is more (understandably) emotional than
ethical, or scientific.  
Amputation now will enable emotional and physical rehab in the very near
future.  Delay, with months of futile surgical heroism will delay and
perhaps eliminate eventual emotional rehab, regardless of the physical
outcome.
I will shut up now.
Ron

>>> <KMATTOX at aol.com> 08/08/06 3:25 PM >>>

In a message dated 8/8/2006 1:45:34 P.M. Central Standard Time,  
sohailmuzammil at hotmail.com writes:

The time  has come to counsel the patient and
amputate (or ablate as Dr. Mattox puts  it).

Regards
S Muzammil, FRCS

This suggestion was also mentioned in our group, by me.   It has  caused
a 
great deal of ethical, moral, and scientific polarization.    The leg is
still 
viable.   The man is a construction worker and wants  to keep his leg.  

k
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SGW to Femoral triangle - Synthetic vs "autogenous"