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Limb salvage after bony and vascular gunshot injuries in a five-week-old infant
R M Nicholas1, V E Boston, J Small
1Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland.
Insights
Temporary vascular shunts, like pediatric nasogastric tubes, significantly reduce ischemia time in combined bone and vascular injuries. This approach allows for fracture stabilization before complex vascular repair, leading to good outcomes in infants.
Area of Science:
- Orthopaedic Surgery
- Vascular Surgery
- Paediatric Surgery
Background:
- Combined bony and vascular injuries pose significant surgical challenges.
- Prompt management is crucial to minimize ischemia time and preserve limb viability.
Observation:
- A five-week-old infant sustained a comminuted femur fracture with associated arterial and venous injuries.
- The injury resulted from a shooting incident, necessitating complex surgical intervention.
Findings:
- Temporary intraluminal vascular shunts, specifically pediatric nasogastric feeding tubes, were utilized to maintain distal circulation.
- Fracture stabilization was performed prior to definitive vascular reconstruction and soft-tissue repair.
- This management strategy resulted in a favorable outcome for the infant.
Implications:
- The use of readily available pediatric nasogastric tubes as vascular shunts offers a viable solution for complex pediatric limb injuries.
- Multidisciplinary surgical expertise is essential for managing combined orthopaedic and vascular trauma in infants.
- This case highlights innovative approaches to reduce ischemia time in pediatric trauma management.
Abstract:
Combined bony and vascular injuries present challenging problems to orthopaedic and vascular surgeons. The use of temporary intraluminal vascular shunts produces significant reductions in ischaemia time and allows fracture stabilisation to be performed before definitive, delicate vascular repair. We report our management of a five-week-old infant who sustained a comminuted fracture of the femur with arterial and venous injuries in a shooting incident. Paediatric nasogastric feeding tubes were used as temporary vascular shunts to re-establish the distal circulation. Stabilisation of the fracture was then followed by vascular reconstruction and soft-tissue surgery, with a good result. We emphasise the need for skills from several surgical disciplines in the management of complex combined injuries.