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.