Crush injury to shoulder / arm from Tractor wheel
-------------------------------------------

Crush injuries are usually difficult to treat when they are around the shoulder girdle and pelvic girdle. Recently a middle aged gentleman was referred to us after giving initial treatment in a local govt hospital. On examination the shoulder, upper limb was crushed, edematous, tense and infected. Clavicle and Corocoid process fracture was noted. There was occlusion of the 2nd and 3rd part of the subclavian artery. Devitalized skin (necrotic skin) around the shoulder and arm was infected. A large collection was noted in the axilla and sub pectoral region. There was significant induration around the clavicle fracture (12 days) and it was looking like phlegmon.

what should be done in such cases?

what is the expected outcome?

By
Pinjala R K

--------------------------------------------------------------------------------------------------

Training in vascular surgery and a career in vascular surgery
----------------------------------------------------------------------------------------------

Peripheral vascular problems are now getting the attention after significant improvement in the cardiac care. There are few vascular surgeons and vascular surgical centers in the country. We will be requiring more number of trained doctors for taking care of the people with vascular problems. The National board of examinations has introduced 3 years course in vascular surgery in 3 centers in India. MCI is also going to start the MCh in vascular surgery in more centers soon. Nurses, technicians and other paramedical staff are needed to complete the vascular surgical services to the patients. At the same the needs of the people with arterial disorders is different from those with venous problems. Majority of the patients are now looking for the day care services and minimally invasive procedures. The hospitals have to gear up to face this challenge by providing new facilities focused around the day care for the vascular (arterial / venous) surgical patients. We hope that there is going to be bright future for those who are opting for the career in vascular surgery.

By
Pinjala RK
-----------------------------------------------------------------------------------------------

What condition is this?

This patient was undergoing cardiac surgery for Atrial septal defect cardiothoracic OT. Then the Cardiac surgeon and anesthetist called for help from the vascular surgeon. The right upper limb was found to be swollen and ischemic on examination by vascular surgeon.

A small procedure was done. What could it be?

What can happen to the limb if unattended?

By
Pinjala R K