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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 was achieved. 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 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 followed the young man up after one month and two month and his wounds were healed, he did not report any swelling at any time and had full mobility and function of his leg. He was very satisfied with the result of his trauma operation. We demonstrated how one can avoid the sequela of lower limb fasciotomies IN APPROPRIATE CASES.
This final image shows the patient at six weeks post op.