Gunshot Wound to the Leg
A 26-year-old male soldier sustained a gunshot wound to the right medial thigh. He had a compressive dressing that was placed prehospital. He arrived at the hospital and underwent a rapid primary and secondary survey.
Initial X-ray
Evaluation?
Radiologic imaging. Evaluation for extremity vascular injury.
He had active bleeding from the wounds. After plain films and initial stabilization, the patient underwent operative exploration of the vascular structures of his right lower extremity. His right femoral artery was intact. His right femoral vein was transected and there was a long segment of destroyed vein, which was treated with ligation. He underwent right lower extremity fasciotomy. This was followed by femur fixation with the placement of an external fixator.
Intraoperative Image
Postoperative Image
Management of Combined Arterial and Orthopedic Injury
In this scenario, the priority is restoring distal arterial blood flow to minimize ischemia time. If there is an associated unstable fracture, blood flow can be re-established with a temporary intravascular shunt, followed by rigid fixation of the bony injury. If the arterial injury is definitively repaired, it can become disrupted with the manipulation required for rigid fixation. If the associated fracture is stable, the arterial injury can be repaired before addressing the fracture.