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Apollo Hospitals Chennai
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Apollo Hospitals, Chennai has successfully performed a complicated Limb saving revascularization procedure on a Georgian patient.

01 Sep 2020

Apollo Hospitals, Chennai has successfully performed a complicated Limb saving revascularization Procedure on a patient from Georgia. The patient sustained crushing injury in his lower limb during his work on a cargo ship that was stationed near Chennai.

Mr. Malkhaz Surmanidze, a 46-year-old from the Republic of Georgia, who is vice captain of cargo ship sustained injury on his right leg on July 23, 2020 while he was working on a cargo ship. His leg got caught in the chain of containers and crushed. He would have lost his life, if he had not been pulled out on time. The ship was docked; he was taken to a hospital close to the Chennai port. He was further referred to Apollo Hospitals owing to his critical leg injury.

Specialists at Apollo Hospitals found that the patient’s leg was swollen and tense with evidence of compartment syndrome with bruise and contusion over right leg and lower thigh, his mid leg to foot were insensate with no movements of right foot (toes and ankle joint). His sole was quickly turning blue, found to have to no palpable pulses below the knee joint showing signs of advancing ischemia. Urgent CT angiogram was done which confirmed popliteal artery injury with reduced flow in the leg vessels. Immediate surgery was suggested to avoid risk of his limb from being removed.

Dr Rajarajan Venkatesan, Senior Consultant Vascular Surgeon, Apollo Hospitals and team moved the patient for emergency surgery with proper protection for COVID prevention. Limb Saving Revascularization (popliteal artery grafting) procedure and Liberal Leg Fasciotomy was performed by the Vascular and Plastic surgery team. Due to extreme injury, patient had developed deadly infection from the crushed muscles. Dr Ram Gopalakrishnan, Consultant Infectious Disease, Apollo Hospitals was involved in the care of the patient. The patient also underwent many Debridement Surgeries to remove the infected and dead muscle tissue, received broad spectrum antibiotics, and after one month of a long fight he recovered from the infection.

As the patient’s wound started healing, skin grafting procedure was done and he was made ambulant with the help of our physiotherapists and started on rehabilitation. The patient is now walking independently and fit to go back to work in a few weeks’ time.

Speaking about crush injuries and the risk involved Dr. Rajarajan Venkatesan, Senior Consultant, Vascular Surgeon Apollo Hospitals said, “Crush injury of extremities with vascular injuries are not uncommon but potentially devastating injuries are a challenge to the vascular surgeons due to bleeding and ischemia. Associated injuries to soft tissue, bone, nerves, contamination of wound, presence of shock, advanced age with comorbid illness also increases the risk of limb loss. Invariably, it is associated with longer hospitalization and ICU stay and carries very high risk of major limb amputation of upto 40%.”

He added, “Early detection and prompt vascular surgical intervention with multidisciplinary approach decreases the risk of amputation, duration of ICU/hospital stay, repeated surgeries and may have better functional outcomes. Even few hours of delay in detection and presentation beyond the golden hour increases the ischemia time and shock, doubles the risk of amputation, and sometimes even risks the life of the individual following vascular intervention due to reperfusion injury which may cause multi-organ failure.”

In all extremity injuries, early recognition of vascular injury and restoration of blood circulation within the golden period of 4 hours is the key to save limb and prevent amputation. Once vascular injury detected or suspected, vascular surgeon needs to be involved or one needs to transfer the patient to tertiary care centre.