Summary of Operation
An incision was made at the opening of the ITPW distally toward the AKA
stump. The wound was unpacked and burrowed deep in the thigh through
several muscle layers. Some necrotic tissue was noticed without gross
purulence. Three areas of arterial hemorrhage were visualized. One
rather large pulsatile vessel traversed the posterior aspect of the
acetabulofemoral joint and was presumed to be the medial circumflex
femoral artery; this was suture-ligated with 0 PDS suture. Two other
arterial vessels were suture ligated with #0 PDS suture in a
figure-of-eight fashion. Approximately 8-10 additional bleeding veins
were oversewn in figure-of-eight fashion with #0 PDS sutures. Various
other smaller areas of hemorrhage were suture ligated with PDS suture as
well. Electrocautery was used to achieve maximal hemostasis. The wound
was packed with epinephrine-soaked lap pads and pressure was held for 15
minutes. Once the pads were removed from the wound, examination revealed
several more areas of bleeding which were suture ligated and/or
cauterized. Additionally, thrombin-soaked Gelfoam was placed in several
areas that appeared to be oozing from the needle holes, and pressure
applied. As the thrombin-soaked Gelfoam was removed, excellent
hemostasis was achieved. At this point in time, Evista was applied to
the base of the wound with tightly packed Kerlix gauze. ABD pads were
placed superficially and, finally, a pressure dressing was applied. The
estimated blood loss was 50 mL. Due to a borderline low hemoglobin level
of 7.5 measured prior to the acute bleeding event, 2 units of pRBCs were
transfused intraoperatively.