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Wed Aug 9 18:09:13 BST 2006

Agree with Dr. Gross. Spare the patient a prolonged hospital stay with a
doubtful outcome at best. "Ablate" early and with the quality of prostheses
available (sadly not here in Pakistan) the gentleman should be able to get
back to work sooner.

Regards
S Muzammil, FRCS
----- Original Message -----
From: "Ronald Gross" <Rgross at harthosp.org>
To: <trauma-list at trauma.org>
Sent: Wednesday, 09 August, 2006 3:50 PM
Subject: Re: SGW to Femoral triangle - Synthetic vs "autogenous"

> Rick,
> I am in complete agreement with all you have said.  My only problem in
> THIS case is that by the description Ken gave us, I can see the
> groin/entire anterior upper thigh gone, leaving very little in the way
> of muscular support/function to the limb.  I too am incredibly sensitive
> to the gentleman's desire to keep his leg - Christ, I would be
> unreasonable in my desire to do the same, I am sure - but I really would
> love to see exactly what is left that would make this a FUNCTIONAL lower
> extremity.
> Be well,
> Ron
>
> >>> <docrickfry at aol.com> 8/8/2006 6:38 PM >>>
> 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"