Venous laceration to lower limb without fasciotomy

A 20 year young man had fallen through glass and sustained an important laceration to the anterior right thigh. His entire limb was swollen, no pulses palpable but arterial flow present on hand-held doppler. At exploration of the hematoma, a completely severed Superficial Femoral Vein was found and a 6 cm long piece of ‘drip set’ inserted as shunt. The backflow of venous blood increased the patients potassium that required therapeutic intervention. The thigh muscles looked dusky and the compartment was left open and the patient rewarmed while intubated in ICU.

A relook procedure was necessary after 7 hours for significant bleeding and hemostasis performed. The next day all the parameters were corrected and the patient had a relook procedure and a gel-coated knitted interposition graft was inserted. The patient was extubated succesfully and his bandaged leg monitored for a venous doppler signal enhanced by calf compression. The thigh wound was managed with a vacuum dressing and will be skin grafted when appropriate.

We believe that the morbidity of a fasciotomy can be avoided by maintaining venous backflow even if a prosthetic graft must be employed. We will report on his follow up in due course.