04/11/2025
Another day at work.
This elderly man met with an accident where he had fractures of both lower limb bones and after that he was in shock. The treating doctor after giving adequate fluids and blood and still not being able to resusciate him, started him on Noradrenaline drip. Unfortunately the canula got displaced and the noradrenalin infusion spread across all soft tissues causing edema and extravasation injury. They then did a fasciotomy and kept doing negative pressure wound therapy for 4 weeks before referring to me for further management.
I did an extensive debridement of the wound, disarticulation of the gangrenous thumb, tendons and soft tissues as I prepare him for flap cover in coming days...Earlier intervention by a plastic surgeon would have been much more useful .
The lesson from this are 2:
1) One needs to be very very careful with canulas to prevent extravasation injury.
2) Early reference and intervention by a plastic surgeon can reduce morbidity and reduce time for healing as they are trained to take proper call for each and every kind of wound and how to treat them for a quick recovery.
For this unfortunate gentleman however due to delay in referral it is going to be a multistage treatment spread over months first to cover his wound and then to restore function of the hand.
