Chennai:Apollo Hospitals, Asia’s largest and most trusted multi-specialty chain of hospitals, successfully completed a complicated Limb saving revascularization Procedure on a patient from Georgia early this month. The patient sustained crushed injury in his lower limb during his work on a cargo ship that was stationed near Chennai.
Mr. MalkhazSurmanidze, a 46-year-old from the Republic of Georgia and a vice captain of a cargo ship sustained an injury on his right leg on the 23.06.2020 while his vessel was at Chennai coast. His leg got caught in the chain of containers (where he would have lost his life which got prevented by pulling his leg from that) and crushed. The ship was docked, he was taken to a hospital close to the Chennai port and he was referred to Apollo Hospitals owing to his critical leg injury. The shifting to Apollo happened after almost 8-10 hours post injury, which made the limb salvage a nearly impossible task as the golden hour in such injuries require medical & surgical intervention within first 4-6 hours.
On emergency examination, Dr RajarajanVenketesan, senior consultant vascular surgeon at Apollo Hospitals found that the patient’s leg was swollen with advanced ischemia 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.
With all precautions Dr. Rajarajan Venkatesan, Senior Consultant Vascular Surgeon, Apollo Hospitals and team moved the patient for emergency surgery with adequate precautions considering covid prevention and performed Limb Saving Revascularization(popliteal artery grafting) procedure and Liberal Leg Fasciotomy. Due to extreme injury patient had developed deadly infection from the crushed muscles and DrRamgopal Krishnan, senior Consultant Infectious Disease, Apollo Hospitals was involved in the care of the patient. He underwent many Debridement Surgeries to remove the infected and dead muscle tissue, received broad-spectrum antibiotics, and after one month of long fight he recovered from the infection. Dr LeelaPraveen , Consultant Plastic &MIcrovascular Surgeon was also involved in the surgical management.
As the patient’s wound started healing skin grafting procedure was done and he was made ambulant with the help of our physiotherapist and started on rehabilitation. The patient was walking independently and fit to join back to his job in few weeks’ time.
Speaking about crush injuries and the risk involved Dr. Raja RajanVenkatesan, Senior Consultant, Vascular Surgeon Apollo Hospitals said, “Crush injury of extremities with vascular injuries are not uncommon but potentially devastating injuries are a challengeto 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 to be involved or to transfer the patient to tertiary care centre.
His Excellency ArchilDzuliashvili Ambassador of Georgia to India visited MrMalkhaz at Apollo Chennai and complimented the Apollo team for the great team effort that could save MrMalkhaz.