A case of successful limb salvage of thigh compartment syndrome and recurrent infections secondary to traumatic external iliac artery injury

Abstract text (incl. references and figure legends)
A 19 year-old male was involved in a unwitnessed motorcycle accident and found lying on the road. He arrived at the emergency department of our hospital.

He was hemodynamically unstable. We could not confirm his active movement of the lower legs. The pelvic ring was clinically unstable. The left thigh was deformed and there were signs of ischemia on the left lower limb.

The plain radiographs on admission revealed the bilateral pubic rami fractures, the sacral fractures, and the left femoral shaft fracture. Enhanced computed tomography showed occlusion of the left external iliac artery.

Left external iliac artery occlusion, unstable pelvic ring fractures, and left femoral shaft fracture.

The patient was admitted to the operating room. The arterial bypass procedure from the base of the external iliac artery to the femoral artery using an artificial vessel was performed. Ischemia time was about 6 hours. The pelvic ring fractures and the femoral shaft fracture were provisionally stabilized with external fixators. He developed the thigh compartment syndrome and fasciotomy of the thigh was applied 3 days after injury. Definitive fixations of the left femur and the pelvis were performed 6 days after injury. Necrotic muscle tissue of the anterior thigh was surgically debrided 10 days after injury. The defect at the left thigh was covered with the free flap which resulted in failure because of infection. Surgical debridement of the thigh had been repeated. The open wound managed to be closed completely 195 days after injury. On the final follow up at two years after injury, he can ambulate with a wheel chair and he was satisfied with the limb salvage though his left lower limb remained completely paralyzed.

Early skeletal stabilizations and persistent multiple debridement of necrotic and infectious tissue were the keys to success for the limb salvage after the external iliac artery injury.

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