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Troubleshooting a Difficult Trans-Tibial/Fibula Amputation: A Case Report

Surgical Science 2023年第6期14卷 414-427页

作者： Amy C. Ross Alejandra Navarro Castaneda Jared D. Stucki Katharine A. Dishner Marisse A. Lardizabal Bryan J. Roth Luis G. Fernandez Samantha A. Delapena Marc R. Matthews Department of Podiatry Valleywise Health Medical Center Phoenix Arizona USA Department of surgery Arrowhead Medical Center Glendale Arizona USA Department of surgery Mountain Vista Medical Center Mesa Arizona USA Valleywise Health Medical Center Phoenix Arizona USA Department of surgery Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler Texas USA school of medicine bill barrett endowed chair in trauma surgery The University of Texas-Tyler Tyler Texas USA trauma Wound Care UT Health East Tyler Texas USA Department of surgery University of Texas Medical Branch Galveston Texas USA Department of medicine and Nursing University of Texas Arlington Texas USA Past Commanding General TXSG Medical Brigade Austin Texas USA Department of surgery Weill Cornell Medical Center New York NY USA Department of surgery New York Presbyterian Hospital New York NY USA Department of surgery Banner University of Arizona/University Medical Center Tucson Arizona USA

Necrotic feet secondary to vascular compromise in the diabetic patient may require an emergent guillotine amputation. Unrecognized, retained hardware in a distal ankle years after fracture repair may complicate the intraoperative guillotine amputation at the transtibial/fibula level. Troubleshooting such an unexpected surgical problem is not necessarily straightforward depending on the clinical situation. Presented is a case report where a patient with a necrotic burned foot failed to inform the burn team that he had implanted ankle hardware, prior to his surgical intervention. A successful amputation was completed after proceeding down a specific algorithm devised for such a scenario.

关键词： Guillotine Amputation Difficult Amputation Amputation Retained Hardware Titanium Plate Trans-Tibia Amputation

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Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation

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Surgical Science 2023年第5期14卷 388-397页

作者： Alexandra N. Dominianni Samantha A. Delapena Luis G. Fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews College of medicine-Phoenix University of Arizona Phoenix AZ USA Creighton university Arizona Health Education Alliance Phoenix AZ USA Department of surgery Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler TX USA the university of texas-tyler school of medicine bill barrett endowed chair in trauma surgery Tyler TX USA trauma Wound Care UT Health East Tyler TX USA Department of surgery University of Texas Medical Branch Galveston TX USA Adjunct Clinical Professor of medicine and Nursing University of Texas Arlington TX USA Past Commanding General TXSG Medical Brigade Austin TX USA Surgical Resident Abrazo Health Network General Surgery Residency Glendale AZ USA Area Sales Manager Miach Orthopedics Surgical Acute Account Manager 3M Minneapolis MN USA Clinical Professor of surgery Banner University of Arizona/University Medical Center Tucson AZ USA

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

关键词： Emphysematous Cholecystitis Gangrenous Cholecystitis Cholecystocutaneous Fistula Necrotizing Fasciitis Sepsis

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