Bicycle accident
Every once in awhile I get surprised....And this was definitely one of those times! The paramedics didn’t know what to do with the leg so they actually had it strapped up onto that orange tourniquet. I have to admit I did chuckle a bit at their ingenuity. This was the result of a pedestrian on a bicycle being struck by a car at about 2:30am on a non-lighted street. Unfortunately when we get an injury like this we don’t have much choice but to complete the amputation. The issue is not the artery or bone but the nerves are so badly damaged that they rarely if ever function properly again. They may function but the limb ends up being almost un usable and the patient can function better with a good prosthesis. On this one I had to do an above the knee amputation (also called an AKA). There wasn’t enough skin, muscle and bone below the knee to make a proper BKA (below the knee amputation) to place a functioning prosthetic. A proper BKA requires about 5-7 inches of bone and of course skin and some gastrocnemius muscle flap to cover the bone. You can use a power saw or a “Gigli” saw which is basically a sharp wire to cut through the bone. The arteries and veins and nerves are identified and tied off with 3-0 silk or vicryl suture (surgeons preference). If it’s a really dirty injury you do a “Guillotine” amputation first, put the patient on antibiotics for a couple days and come back to the OR when it’s clean and do the formal closure of the amputation. This one was really clean and I ended up completing the amputation above the knee in the first and only operation. I got a bunch of sh*t from the senior surgeons for it but there was no complication or post op infection....God I LOVE being right! (Of course some say I was just lucky...but you know what they say..better lucky than good!). Have you seen a BKA or an AKA? Tell me about it! from @drbuckparker
I really liked the way you explained the case to us. Thank you for the information. Also as a 3. year med student, I always wondered if amputee patients suffer from anemia in the future, since along with the bone they lose the marrow..
Most of the amputations I have scrubbed for were revisions of a traumatic amputation. Too bad the joint couldn't be salvaged...too severe damage😟 always find it odd that a limb can be 99% ripped off yet still have an attachment by one small piece of skin. Worst amputation I can remember was a woman run over by a streetcar and trapped when it derailed. A team was sent out to amputate her leg right there on the road. I was glad to be neuro that night and didn't have to do a field amputation!
