Leg Fasciotomy Research Paper

Jane presented with a wound to her lower left leg which, following a holistic assessment (appendix 2), was diagnosed as a venous leg ulcer. The assessment was conducted in accordance with Local PCT Leg Ulcer Guidelines (appendix 3) as well as RCN Guidelines (RCN 2006) to rule out other possible aetiology such as arterial ulceration, diabetes or malignancy (Moloney and Grace 2004). Although traditionally considered uncommon, recent studies suggest that malignant ulcers are more prevalent than previously thought (Miller et al 2003, Taylor 1998) therefore even though initial assessment suggests an uncomplicated venous ulcer, if Jane’s wound fails to heal following appropriate treatment then specialist advice will be sought. Between 17% and 65% of people with a leg ulcer experience severe or continuous pain with a major impact on quality of life (Briggs and Nelson, 2003) and effective pain relief is important to maximise quality of life, to enable mobilisation and improve appetite to facilitate wound healing. Fortunately, Jane experienced no pain from the leg ulcer prior to or at the time of assessment. However, careful review and monitoring of any pain will be important throughout the treatment process as the first line of treatment for uncomplicated venous leg ulcers are compression systems (RCN 2006) and although compression counteracts the harmful effects of venous hypertension and

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this

Surgical procedures were as simple as having two assistants pinning the patient down while the surgeon cut off the soldier's wounded limb. These surgical procedures were usually done by a butcher. Wounds were caused by muskets or the bayonet. In order for the wounds to be treated, in a surgical procedure, the surgeon would use his amputation knife to cut down to the bone of the damaged limb. Only thirty-five percent of the patients who went through this procedure survived and the rest died due to shock, loss of

Amputations were intended to prevent gangrene, which is a deadly complication resulting from obstructed circulation or bacterial infection ("History of Medicine," 2011). When legs were amputated, patents waited for artificial limb designs to be accommodated for them. Around 150 patents were issued for artificial limbs between 1861 and 1873, the industry then expanded to benefit the veteran population ("History of Medicine," 2011). It costed veterans $75 to buy an artificial leg and $50 for an arm, the Confederacy then provided financial assistance in 1864 for purchases ("History of Medicine," 2011). Gunshot and explosive wounds carried many types of injuries with them like comminuted fractures, compound fractures, and wounds of joints ("The Call," n.d.). Comminuted fractures are where the bone is broken, splintered, or crushed into different pieces, which demands amputation ("The Call," n.d.). While compound fractures on the other hand are when bone comes through the skin; May require amputation if in a large limb like a leg, thigh, arm, or forearm ("The Call," n.d.). Injuries that almost always needed amputations were wounds to the joints such as the knee joint, elbow joint, shoulder joint, wrist, ankle, and hip joint. Most of all of these injuries could have been treated with better care with the medical procedures we have

What I mean by a couple of pair of hands is one pair for the surgeon and another pair to hold you down when you scream in agony while the surgeon cuts off your leg manually with a saw. And all you have is a towel to bite to keep you sane during the process. Sounds fun right? After they finished digging through your bone they will wrap it up with bandages and raise it up to reduce as much as blood lost when you are

venous leg ulcers and diabetic foot ulcers. Canadian Association of Wound Care (CAWC) has published

It required considerable surgical skill. Resection also carried a high risk of profuse bleeding and infection. Successful resections allowed the patient to keep the limb, although it was limp and useful to merely “fill a sleeve”. An amputation was a surgery where a circular cut was made completely around the limb, the bone was sawed through and the blood vessels and arteries were sewn shut. To prevent future pain, the nerves were pulled out as far as possible, cut, and released to retract away from the end of the stump. Clippers and a rasp were used to smooth the end of the exposed bone. Sometimes the raw and bloody stump was left untreated to heal gradually, sometimes the excess skin was pulled down and sewn over the wound. Speed was essential to lessen blood loss and prevent shock. An amputation at the knee was expected to take 3 minutes. It was also the most common civil war surgical procedure.

The recommendations for change to practice at the level of the provider would include first treating the underlying problem that Mrs. Smith was admitted for. According to the literature, a progressively worsening diabetic foot ulcer involves implementing a multitude of strategies to prevent amputation of the limb. This allow for decreased rates in mortality and can increase quality of life. Adequate wound management such as debridement, and offloading techniques should be instilled. Furthermore, education by the provider would be of critical importance for Mrs. Smith in terms of consistent foot care and management of her disease process (Yazdanpanah, Nasiri, & Adarvishi, 2015). Due

Intervention Procedure: Following the diagnostic portion of the procedure, the left femoral vein was accessed under ultrasound guidance with a 21 gauge thin wall needle. A double lumen 4 -French (5 cm in length) was placed percutaneously into the left femoral vein by modified Seldinger technique with guide-wire exchange. Blood was withdrawn from all lumens and flushed with normal saline. The catheter was sutured in place and a sterile dressing was applied over the site prior to removal of drapes.

Imagine being a surgeon, you have to stay in cramped room with everyone watching you take out a tumor. Can you handle that amount of pressure? In the Civil War surgeons actually didn't have the tools to amputate the injury, so they had to saw off the leg.There are many types of surgery on specific body parts like for example heart surgery, brain surgery, and even plastic surgery.

Compartment syndrome results when parenchymal interstitial pressure exceeds capillary perfusion pressure. In the vast majority of cases compartment syndrome develops as a result of intrafascial swelling caused by edema associated with ischemia/reperfusion injury or musculoskeletal trauma. When the pressure exceeds the pressure of compartment capillary perfusion by more than 30 mmHg, compartment muscle ischemia occurs. After 6-8 hours of ischemia, irreversible muscle necrosis within the compartment occurs. Currently clinical Fig. 1. a Dorsal forearm and hand wounds 8 days post fasciotomy and closure. b Volar forearm fasciotomy at the 2nd revision post fasciotomy. Dead muscle tissue was sharply resected. There was no bleeding, no contractility, and poor consistency. a b

This surgery was performed three days following the accident, due to swelling of the affected limb.

The National Institute for Health and Care Excellence (NICE) defines leg ulcer as the loss of skin on the leg below the knee or foot, which takes more than 2 weeks to heal. Venous leg ulceration is due to sustained venous hypertension, which results from chronic venous insufficiency and/or an impaired calf muscle pump. Venous leg ulcers

Lower leg breaks, metatarsal cracks, and Lisfranc cracks can sideline competitors and once in a while require surgery.

The diabetic foot disease is the leading cause of non-traumatic lower-limb amputation and results from three common pathologies: diabetic peripheral neuropathy, peripheral arterial disease, and infection. Late complications include foot ulceration, Charcot neuroarthropathy and amputation (Turns, 2013, p.422) though another specialist like, Iraj who wrote Prevention of Diabetic Foot Ulcer, added to the most common facts: deformities and minor