Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries

Abstract

Fig. 1a: 3D Computed tomography (CT imaging) revealed right bicolumnar acetabulum fracture, fracture left superior and inferior pubic rami, fracture right neck of femur. Fig. 1b: Initial radiograph right knee showing right knee dislocation. Fig. 1c: 3D reconstruction Computed Tomography (CT Imaging) revealed thrombosed of right popliteal artery on dislocated knee. Fig. 1d: Pelvic radiograph following open reduction and ring internal fixation showing acceptable alignment, screw fixation neck of femur in situ. Fig. 2a: A Photograph of open pelvic fracture wound. Fig. 2b: 3D Computed Tomography (CT imaging) showing left superior and inferior pubic rami fracture, and opening of left sacroiliac joint. A twenty-three-year-old young man motorcyclist was involved in a collision with a car and presented with profuse bleeding over the perineum. There was an open laceration wound over the medial aspect of left proximal thigh extending to the perianal region measuring about 10 x 2 cm with continuous blood oozing. (Fig 2-A). Computed tomography (CT) scans demonstrated severe pelvic injuries, including a left superior and inferior pubic rami fracture with left sacroiliac joint disruption (Fig 2-B). The hypovolemia was transient and was managed with fluid resuscitation and 3 pints of blood transfusion. There was proximal tibial plateau fracture in the contralateral limb with popliteal artery thrombosis of 4 cm with good collaterals and distal run-off. (Fig 2-C) Emergency debridement of the perineal wound and pelvic packing through modified Stoppa approach were done. The bleeding was secured by clipping multiple branches of internal iliac artery and veins particularly the obturator anastomoses. The pelvis was then stabilized with a long plate. (Fig 2-D). The right popliteal vessel exploration and revascularization using saphenous vein graft were done 8 hours after injury. He was managed in ICU for 48 hours and there was no evidence of reperfusion injury. The creatine phosphokinase was 8588 U/L during first 24 hours and normalized within 3 days. No evidence of reperfusion injury and renal and lung functions were normal throughout the acute event. The total duration of hospital stay was 16 days.