A 17-year-old boy was brought to Billroth Hospitals, run over by a bus when he tried to alight from it. The boy was in septic shock status during his arrival. In the Emergency Room, his haemoglobin was 4gm and he was running a high temperature. On examination, he had severe inflammation of the fascia and rapid destruction of overlying tissues on both thighs with partly dead muscle fibres. The thigh bone was exposed in the left side with purulent discharge. He also had a pelvic fracture, a colostomy, suspected urethral injury and multiple rib fractures.
Billroth Hospitals multi-disciplinary team performs yet another zero-delay ground-breaking trauma care intervention
The teenager was resuscitated in the Emergency Room, shifted to the Critical Care Unit (CCU) and stabilised. Though the process of management looked like a herculean task, the multidisciplinary team discussed and decided on a surgery instantly soon after the blood transfusion. The panel of experts from the team geared up and operated on the boy.
The Cardiothoracic team comprising of surgeons Dr. Arunkumar and Dr. Bharat Guru and anaesthetist, Dr. Mahadevan and Dr. Nedumaran did an intercostal tube placement to inflate his lungs. The orthopaedic surgeon, Dr Balaji Saibaba, stabilised the pelvic fracture with external fixators. The urologist, Dr. AC Mani, used a guidewire to catheterise the bladder and a trained stoma nurse changed the colostomy bag to fit properly. The plastic Surgeon, Dr. Pablo Neruda, debrided the thighs removing dead skin, fat and fascia while trying to preserve as much healthy muscle as possible.
After thorough debridement, the boy was shifted back to the CCU. At the CCU, the boy was managed with great care by Dr. Chakravarthy & Team. 48 hours later the patient was examined again in the Operation Theatre. The team of anaesthetists at the Operation Theatre, Dr. Rangarajan & Dr. Suresh also handled the patient well. Thus the wound was managed efficiently and as there was no residual dead tissue, muscle flap was taken to cover the exposed bone in his thigh and vacuum dressings were done.
The marathon task of treating the boy didn’t sail easily without complications. Plans for an early skin cover were derailed as the patient’s pre-existing abdominal wound burst open, necessitating an abdominal wound closure by the surgical gastroenterologist, Dr. Sivaraj. The patient also developed a urethral fistula which needed a catheterisation.
After nearly a month with vacuum dressings, the boy was taken up for skin grafting in stages due to paucity of donor areas in the thighs. A mesher was used to obtain meshed skin grafts which were done at a 2 weekly interval. At about the time the grafts were settling the urologist catheterised the bladder and closed the existing supra-pubic catheter.
After about 2 months, after obtaining enough nutritional fortitude the patient’s colostomy was closed and the external fixators were removed. After a near-death experience, multiple surgeries, a prolonged stay in the hospital and multiple follow-ups the boy is now able to walk and is appearing for his class 12 exams. The costs for the treatment protocol mounted up enormously and the patient was unable to bear the expenses. Seeing the critical state of the young teen the benevolent management of Billroth Hospitals shouldered the boy’s family by bearing the cost and waiving off certain charges. This patient’s recovery is an excellent example of zero-delay multidisciplinary teamwork at Billroth Hospitals.
For more details, please contact: Shenoy Nagar: 044-4292 1777/+91 72994 04040; RA Puram: 044 – 2464 1111/+91 89392 04040.
With the vast experience of handling high-risk trauma care cases like these, Billroth Super-speciality Hospitals stands tall as a pioneer in healthcare at Chennai. Billroth Hospitals is equipped with all the latest diagnostics & techniques prevalent in the industry and is strongly backed with an existing expert panel of doctors to handle critical cases. The hospital under the able leadership of Dr. Rajesh Jeganathan pledges to render the highest quality medical care at an affordable cost to patients from all walks of life with empathy and expertise.