Pa. Clugston et al., REVASCULARIZATION OF A 7-WEEK-OLD INFANT LOWER-EXTREMITY - CASE-REPORT, Journal of reconstructive microsurgery, 11(2), 1995, pp. 107-111
A seven-week-old infant suffered a closed segmental fracture of the le
ft tibia and fibula complicated by vascular disruption and a secondary
compartment syndrome. Initial orthopedic assessment revealed a clinic
ally mottled, cool, pulseless extremity 4 hr post-injury. Radiologic i
nvestigations showed multiple displaced fractures of both the tibia an
d fibula. The infant underwent four compartment fasciotomies and intra
medullary nailing of the tibial fractures. The vascularity of the limb
failed to improve significantly Angiograms done 22 hr post-injury rev
ealed disruption of arterial inflow just distal to the bifurcation of
the tibial peroneal trunk and posterior tibial artery. Urgent revascul
arization utilizing a contralateral greater saphenous vein graft was u
ndertaken with a successful outcome. Despite delay in transport from t
he community hospital and lack of definitive management of the vascula
r injury, the infant has had a good-to-excellent functional outcome.