Extracorporeal Circulation in a Trauma Patient: An Unusual Case of Selected Lower Limb Perfusion
22 January 2018 (online)
Objectives: Extracorporeal life support systems (ECLS) are designed for whole body perfusion. We report on a case with selective perfusion of an amputated leg to enable autologous tissue donation for reconstructive surgery.
Methods: A 23-year-old patient suffered complete amputation of the right leg at the level of the pelvic ring along with multiple bone fractures, intestinal prolapse, and burn injuries during a car accident. After hemodynamic stabilization it was decided to selectively perfuse the amputated right leg with an ECLS system to maintain viability of the tissue, which can then later be used for reconstructive surgery for the pelvic ring. The femoral artery and vein were cannulated (14/18 Fr) and limb perfusion established with 1 L/min for 12 hours under massive volume substitution. Thereafter, the pelvic ring was reconstructed utilizing tissue from the amputated leg.
Results: After 5 months, the patient could be discharged to a rehabilitation center, and a prosthetic leg was customized. Meanwhile, the patient is back to work.
Conclusion: Selective perfusion of amputated body parts with ECLS can be performed for maintain tissue viability for later reconstructive surgery. ECMO centers should be aware of this possibility.