Sandhu Jaspreet, La Punzina Charles, Kothuru Ravi
Department of Surgery, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, United States.
Trauma Case Rep. 2018 Apr 24;15:32-35. doi: 10.1016/j.tcr.2018.04.007. eCollection 2018 Jun.
This is a case report describing the delayed presentation of injury to all three lower extremity infrapopliteal arteries after a 34 year old male sustained multiple gunshot wounds, including one to his left lower extremity. As part of his initial assessment, ankle brachial index was performed and was found to be abnormal. Further work up for this was delayed due to need for emergent trauma laparotomy. After this procedure, more detailed evaluation with CT angiography of the extremity injury was performed. Though imaging indicated adequate perfusion of the lower extremity, serial neurovascular examination revealed inadequate perfusion. The patient required arterial reconstruction and fasciotomies. This case demonstrates the need for continued surveillance of extremity perfusion in atypical trauma cases when index of suspicion suggests the degree of injury may be worse than initial work up may indicate.
这是一份病例报告，描述了一名34岁男性遭受多处枪伤，包括左下肢一处枪伤后，其下肢腘动脉以下的三条动脉损伤出现延迟的情况。作为初始评估的一部分，进行了踝肱指数测量，发现结果异常。由于需要紧急进行创伤性剖腹手术，对此进一步的检查被推迟。在此手术后，对肢体损伤进行了更详细的CT血管造影评估。尽管影像学检查显示下肢灌注充足，但连续的神经血管检查显示灌注不足。患者需要进行动脉重建和筋膜切开术。该病例表明，在非典型创伤病例中，当怀疑指数提示损伤程度可能比初始检查结果所显示的更严重时，需要持续监测肢体灌注情况。
