Background: In the recent era of trauma majority of people suffer from lower limb injuries, which cause functional disabilities and psychosocial consequences. Lower limb injury specially below knee generally involves young and productive people so it is the prime responsibility of the society to prevent such incidents. Our aim is to study clinical profile of various below knee soft tissue injuries to develop better prediction models for defining the most important target for prevention and to reduce morbidities and disabilities.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months. Subjects were recruited from patients presenting in Emergency/Surgery OPD, HIMS, Dehradun with a primary diagnosis of below knee soft tissue injuries. A total of 64 patients were included in the study.Results: Maximum number of patients were in the age group of 20-40 years (46.88%), and were predominantly males (84.38%). The commonest mode of injury was RTA (75%) primarily involving 2 wheelers (72.91%). Most patients (42.18%) had late presentation to the hospital i.e. after 72 hours of injury which was found to be associated with contamination of wound in 66.6% of patients.Conclusions: The study emphasizes the need for preventive strategies and protection mechanisms for lower limb injuries. Late presenting contaminated wounds leads to higher complication rates hence there is need for efficient ambulance services for ensuring timely intervention.
Background: Treatment of lower limb injuries pose a great challenge. Debridement is the key to success in the management of major limb injuries followed by soft-tissue coverage in the form of suturing, skin grafts, or flaps. Our aim is to study the management of various below knee soft tissue injuries.Methods: The study was conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months. Subjects were recruited from patients presenting in Emergency/Surgery OPD, HIMS, Dehradun with a primary diagnosis of below knee soft tissue injuries. A total of 64 patients were included in the study.Results: Primary closure was done in 6 wounds and coverage in rest, with maximum in the form of split skin graft. Abrasion wounds were managed without any surgical intervention. Reconstructive surgery was performed two or more times in 39.06% patients. Local complications were seen in 23.43% of patients and general complications AKI and Tetanus in 2patients.68.75% of patients with local complications were observed to have contaminated wound status at the time of presentation. The average duration of hospital stays ranged between 3 to 56 days. Majority of the patients were discharged within 1 to 3 weeks with mean duration of hospital stay being 17.82±10.95 days.Conclusions: Proper debridement, early coverage of wounds and prompt identification and management of complications is the key to success in the management of lower limb trauma.
DIVC may play a role as a confounding factor in imaging diagnostic tests and also may represent a hazard for inadvertent injury and bleeding during surgery. Careful interpretation Radiological investigations help to define such anomalies and avoid significant morbidity during surgical exploration. We present a case of renal cell carcinoma involving Right kidney with tumor thrombus extending into both venae cava. Triphasic Contrast-Enhanced Computerized Tomography (CECT) scan of abdomen with three-dimensional reconstruction showed duplicated left sided IVC, Heterogeneously enhancing intraluminal soft tissue density filling defect was seen along the entire length of right renal vein, also crossing the midline to the left sided duplicated IVC -s/o tumour thrombus. Patient underwent right radical nephrectomy with tumour thrombectomy. Cavotomy was done at the junction of right renal vein and right IVC. Entire thrombus was delivered intact. Histopathological examination showed papillary renal cell carcinoma (type II) stage pT3bN1Mx. IVC thrombus showed clusters of malignant cells of same morphology as tumor entangled in thrombus. The patient is doing well at 3 months of follow-up.
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