Amputation of an unsalvageable post-traumatic limb in a young Haemophiliac: A multi-faceted clinical dilemma
Author(s): Joshi Prateek C, Chhattani Tushar M, Shreesha Parthaje and Rishi Raj
Abstract: A twenty-nine-year-old male presented to the emergency ward of our institute with a history of having been involved in a road traffic accident with a heavy motor vehicle (HMV), 18 hours ago, with trauma to his left lower limb. Arteriovenous Doppler evaluation of the affected limb confirmed devascularization, and radiographs showed fracture of the femur in supracondylar region and tibial diaphysis with significant soft tissue injury (Letts and Vincent type D floating knee). Due to the prolonged ischemia time of 18 hours, the Mangled Extremity Severity Score (MESS) of 10, and the contaminated nature of the wound, it was decided to proceed with Guillotine above-knee amputation. However, a detailed history-taking revealed the patient to be a sufferer of Hemophilia Type A (Coagulation factor VIII deficiency). The patient was stabilized hemodynamically, and supplemented with Factor VIII following which the amputation was done successfully. This case report documents his perioperative and postoperative course in the hospital, ending with his discharge with a small wound healing by secondary intention. Surgical procedures in hemophiliacs have always presented as clinical dilemmas, with increased blood loss, poor tissue perfusion, and infective events adding to the postoperative complications. Lower limb amputations in sufferers of hemophilia are very rare, with less that fifty cases being found in the global medical literature. A meta-analysis of said cases reveals the vast majority to have been due to infective indications or for management of hemophilic pseudo-tumours, and post-traumatic above knee amputations are virtually unheard of in such a clinical scenario. The presence of a traumatic vascular insult in this case, provided a rare clinical predicament, and the successful management of this Catch-22 situation makes for a unique situation.
Joshi Prateek C, Chhattani Tushar M, Shreesha Parthaje, Rishi Raj. Amputation of an unsalvageable post-traumatic limb in a young Haemophiliac: A multi-faceted clinical dilemma. Int J Case Rep Orthop 2020;2(2):79-83. DOI: 10.22271/27078345.2020.v2.i2b.33