Crush Injury of Left Cruris Region with Vascular Injury: A Case Report

Authors

  • Richard Sumangkut Universitas Sam Ratulangi
  • Ira Frayanti Universitas Sam Ratulangi

DOI:

https://doi.org/10.35790/ecl.v13i3.61594

Abstract

Abstract: Crush injuries resulting from traffic accidents, cause severe damage to soft tissues, muscles, and nerves, leading to complications such as compartment syndrome and vascular injury. Vascular injuries may require timely diagnosis and intervention to prevent limb loss or death. Through-knee amputation (TKA) with anterior flap is an effective technique for preserving limb function while minimizing amputation extent. The procedure is less complex, reduces infection risks, and promotes better healing compared to more extensive amputation methods. We reported a 46-year-old male who suffered from a severe traffic accident resulting in intense pain and significant bleeding in the left lower leg (cruris sinistra). Upon physical examination and vital signs, no abnormal findings were noted. The local examination revealed an open fracture with surrounding tissue avulsion in the left lower leg, with a MESS of 8. X-ray and Doppler ultrasound confirmed tibia and fibula fractures with associated vascular damage. The patient underwent a through-knee amputation (TKA) with an anterior flap, aimed at preserving limb function while addressing severe vascular and soft tissue damage. Comprehensive follow-up care, including adequate antibiotics, post-surgical transfusion, analgesics, rehabilitation, and psychological support, was provided to promote recovery. In conclusion, through-knee amputation is a viable option for patients aiming to preserve as much limb function as possible, providing significant long-term benefits, followed by post-operation ambulatory and rehabilitation. This case highlights the successful outcome of TKA, with complete wound closure after one week of care, and emphasizes the importance of comprehensive post-operative rehabilitation, including physical therapy, occupational therapy, and psychiatric support, to enhance the patient's quality of life and functional recovery.

Keywords: crush injury; vascular injury; through-knee amputation

Author Biographies

Richard Sumangkut, Universitas Sam Ratulangi

Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi - Prof. Dr. R. D. Kandou Hospital, Manado, Indonesia

Ira Frayanti, Universitas Sam Ratulangi

Department of Surgery, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia

References

Arango M, Cruz D, Salcedo A, Marin G. Amputation in crush syndrome: a case report. Int J Surg Case Rep. 2020;72(8):346-50. Doi: 10.1016/j.ijscr.2020.05.087

Kusumastutie N, Patria B, Hastjarjo T, Kusrohmaniah S. A review of accident data for traffic safety studies in Indonesia. IOP Conference Series Earth and Environmental Science. 2024;1294(1):0120123. Doi:10.1088/1755-1315/1294/1/012012

Rama E, Jayawant S, Zhang J, Krkovic M. Crush injuries to the lower limbs at a major UK trauma centre: a retrospective observational study. Eur J Orthop Surg Traumatol. 2024;35(1):44. Doi: 10.1007/s00590-024-04164-6

Rajagopalan S. Crush injuries and the crush syndrome. Med J Armed Forces India. 2010;66(4):317-20. Doi: 10.1016/S0377-1237(10)80007-3

Long B, Liang SY, Gottlieb M. Crush injury and syndrome: a review for emergency clinicians. Am J Emerg Med. 2023;69(46):180-7. Doi: 10.1016/j.ajem.2023.04.029

Loja M, Sammann A, DuBose J, Li CS, Liu Y, Savage S, et al. AAST PROOVIT Study Group. The mangled extremity score and amputation: time for a revision. J Trauma Acute Care Surg. 2017;82 (3):518-23. Doi: 10.1097/TA.0000000000001339

Malcolm J, Mahmooth Z, Rindler R, Allen J, Grossberg J, Pradilla G, et al. Autologous cranioplasty is associated with increased implant failure rate: a systematic review and meta-analysis. World Neurosurg. 2018;116(113):60–8. Doi: 10.1016/j.wneu.2018.05.009

Choo YJ, Kim DH, Chang MC. Amputation stump management: a narrative review. World J Clin Cases. 2022;10(13):3981-8. Doi: 10.12998/wjcc.v10.i13.3981

Yoneda H, Takeda S, Saeki M, Iwatsuki K, Yamamoto M, Tatebe M, et al. Utility of severity scoring systems for mangled upper limb salvage: a systematic review and meta-analysis. Injury. 2024;55(4):111447. Doi: 10.1016/j.injury.2024

Ntola V, Hardcastle T. Diagnostic approaches to vascular injury in polytrauma—a literature review. Diagnostics. 2023;13(6):1019.11. Doi: 10.3390/diagnostics13061019.

Panhelleux B, Shalhoub J, Silverman A, McGregor A. A review of through-knee amputation. Vascular. 2022;30(6):1149-59. Doi: 10.1177/17085381211045183

Zink TM, Gonzalez AG, Coden G, Smith E, Bono J. Outcomes of total knee arthroplasty following a Sham incision procedure in patients with previous knee incisions. J Bone Joint Surg Am. 2024;106 (21):1986-90. Doi: 10.2106/JBJS.24.00114

Lim S, Javorski MJ, Halandras PM, Aulivola B, Crisostomo PR. Through-knee amputation is a feasible alternative to above-knee amputation. J Vasc Surg. 2018;68(1):197-203. Doi: 10.1016/j.jvs.2017.11.094

Crane H, Boam G, Carradice D, Vanicek N, Twiddy M, Smith G. Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations. Cochrane Database Syst Rev. 2021;12(12):CD013839. Doi: 10.1002/14651858.CD013839.pub2

Gordon H, Hebenton J, Dave S, Twiddy M, Smith G, Carradice D. Surgical and rehabilitation outcomes of patients undergoing through knee amputation compared with above knee amputation. Journal of Vascular Societies Great Britain & Ireland. 2023;2(4):208-14. Available from: http://doi.org/10.54522/jvsgbi.2023.081

Dewi M, Gwilym B, Coxon A, Carradice D, Bosanquet D. Surgical techniques for performing a through-knee amputation: a systematic review and development of an operative descriptive system. Annals of Vascular Surgery. 2023;93(3):428-36. Doi: 10.1016/j.avsg.2022.12.089

Albino FP, Seidel R, Brown BJ, Crone CG, Attinger CE. Through knee amputation: technique modifications and surgical outcomes. Arch Plast Surg. 2014; 41(5):562-70. Doi: 10.5999/aps.2014.41.5.562

Guo S, Hinchliffe RJ. Through knee amputation: a neglected technique that offers opportunities for future research. Eur J Vasc Endovasc Surg. 2023;66(5):607-8. Doi: 10.1016/j.ejvs.2023.09.001

Sharif A, Michael G. Vascular trauma. Surgery. 2012;30(12):399-404. Available from: https://doi.org/ 10.1016/j.surg.2012.11.007

Walthert L, Ris M, Moerenhout K, Déglise S, Di Summa P, Steinmetz S. Modified Gritti-Stokes amputation: tips and tricks. EFORT Open Rev. 2024;9(4):276-84. Doi: 10.1530/EOR-23-0118

Gordon H, Boam G, Carradice D, Smith G, Twiddy M. Exploring UK clinician perceptions of through-knee amputation compared to above-knee amputation: a mixed methods study. Disabil Rehabil. 2024;27(1):1-8. Doi: 10.1080/09638288.2024.2441423

Met R, Janssen LI, Wille J, Langezaal A, van de Mortel RWH, van de Pavoordt EDWM, et al. Functional results after through-knee and above-knee amputations: Does more length mean better outcome? Vasc Endovascular Surg. 2008; 42(5):456-61. Doi: 10.1177/1538574408316914

Jo SH, Kang SH, Seo WS, Koo BH, Kim HG, Yun SH. Psychiatric understanding and treatment of patients with amputations. Yeungnam Univ J Med. 2021;38(3):194-201. Doi: 10.12701/yujm.2021.00990

Downloads

Published

2025-06-18

How to Cite

Sumangkut, R., & Frayanti, I. (2025). Crush Injury of Left Cruris Region with Vascular Injury: A Case Report. E-CliniC, 13(3), 370–375. https://doi.org/10.35790/ecl.v13i3.61594

Issue

Section

Articles