SGW to Femoral triangle - Synthetic vs "autogenous"

[Ronald Gross]

Rick,
I am in complete agreement with all you have said.  My only problem in
THIS case is that by the description Ken gave us, I can see the
groin/entire anterior upper thigh gone, leaving very little in the way
of muscular support/function to the limb.  I too am incredibly sensitive
to the gentleman's desire to keep his leg - Christ, I would be
unreasonable in my desire to do the same, I am sure - but I really would
love to see exactly what is left that would make this a FUNCTIONAL lower
extremity.  
Be well,
Ron

>>> <docrickfry at aol.com> 8/8/2006 6:38 PM >>>
I agree with this and am very sensitive about removing a doomed limb at
the earliest time, but right now we are just days, not weeks and months,
into it, and there is really no indication of inevitable doom just yet. 
The LEAP study published in several installments in the NEJM has clearly
shown that some of the old maxims guiding the need for early amputation
have fallen by the wayside as data drives by--i.e. loss of plantar
sensation, Gustilo III-C injuries, severe venous insufficiency, etc etc
have all shown surprisingly good salvage of reasonably functional limbs
with present technology.  In view of the patient's wishes to continue,
and no overriding reason to amputate at present, I think it is
reasonable to give the wounds a chance to heal and attempt an
extra-anatomic bypass within a few days if at all feasible.
ERF 
 
 
-----Original Message-----
From: rgross at harthosp.org 
To: trauma-list at trauma.org 
Sent: Tue, 8 Aug 2006 3:50 PM
Subject: Re: SGW to Femoral triangle - Synthetic vs "autogenous"


Ken,
While the leg might be viable, is it or might it still be FUNCTIONAL. 
As I try to envision the destruction to the groin and upper thigh as
described, a wonder if there will be any FUNCTION or if he will
instead
be dragging a viable, non-functional appendage, much as a sailboat
would
drag her anchor in a storm.......
My guess is, knowing Dr. Mattox, that the leg will not be functional,
and the debate now raging is more (understandably) emotional than
ethical, or scientific.  
Amputation now will enable emotional and physical rehab in the very
near
future.  Delay, with months of futile surgical heroism will delay and
perhaps eliminate eventual emotional rehab, regardless of the physical
outcome.
I will shut up now.
Ron

>>> <KMATTOX at aol.com> 08/08/06 3:25 PM >>>
 
In a message dated 8/8/2006 1:45:34 P.M. Central Standard Time,  
sohailmuzammil at hotmail.com writes:

The time  has come to counsel the patient and
amputate (or ablate as Dr. Mattox puts  it).

Regards
S Muzammil, FRCS



This suggestion was also mentioned in our group, by me.   It has 
caused
a 
great deal of ethical, moral, and scientific polarization.    The leg
is
still 
viable.   The man is a construction worker and wants  to keep his leg. 


 
k
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