UNPREDICTABLE COMPLICATIONS IN LOWER LIMB TRAUMA.

Background: In the realm of trauma surgery each traffic accident is unique, testing medical expertise. Objective: The objectives were to preserve and restore functionality of the affected limbs following trauma. Material and methods: We will analyse the case of a 23-year-old woman who was riding a bycicle, got hit bya garbage truck and was directed to the Plastic-Surgery-Departament. She suffered severe injuries, including total crush injury of the right lower limb and partial skin avulsion of the left leg. Four surgical interventions were performed. The initial procedure was conducted urgently upon the patient's arrival. It involved surgical cleansing and assessment of injuries to both lower limbs, coupled with an arteriovenous graft insertion at the right forefoot to prevent amputation. Subsequently, complications arose, leading to the graft's thrombosis. Deliberations involving the patient and her family, led to the decision to perform a second surgery: amputation at the mid-third level of the right calf, facilitating future prosthetic fitting. In the following days, the left lower limb developed necrosis, necessitating a third surgical intervention: necrectomy of the skin around the left knee. Following this procedure, negative pressure wound therapy was initiated in that area. After six days of employing negative pressure therapy, granulation tissue formation around the knee enabled the execution of a fourth surgical procedure: a split-thickness-skin-graft application. By the multitude of post-avulsion complications, a hematoma formed on the outer side of the left hip, prompting another necrectomy during the same operation. Subsequently, negative pressure wound therapy was applied to the hip area as well. Results: In addition, the patient's progress was altered by contamination with pathogenic bacteria, including E.Coli, Pseudomonas Fluorescens/Putida, and the rare Aeromonas Hydrophila. Further surgical management of the left lower limb is planned. Conclusions: The circumstances and severity of the accident give unexpected complications and a prolonged evolution. The prognostic of these crush injury cases is reserved. [ABSTRACT FROM AUTHOR]