TY - JOUR T1 - Shotgun wound to the left groin JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000887 VL - 7 IS - 1 SP - e000887 AU - David V Feliciano AU - Grace F Rozycki Y1 - 2022/02/01 UR - http://tsaco.bmj.com/content/7/1/e000887.abstract N2 - A boy aged 16 years suffered a close-range shotgun wound to the left groin. A pressure dressing applied in the field by the emergency medical services was saturated with blood when the patient arrived at the trauma center.The patient was agitated and uncooperative. His blood pressure was 80/50 mm Hg, heart rate was 140 beats/min, and respiratory rate was 20 breaths/min with audible breath sounds bilaterally. While the patient was being intubated and intravenous catheters were being inserted, an arterial blood gas was drawn and an X-ray of the left groin was performed (figure 1). The results of the arterial blood gas were a pH of 6.89 and a base deficit of −24.8. The pressure dressing over the left groin was reinforced, and the patient was moved to the operating room. He was noted to be moving his left ankle and toes.Figure 1 X-ray of close-range shotgun wound of left groin.Once the pressure dressing was removed, extensive damage to the soft tissues of the left groin was noted. After a longitudinal incision was made through this area, a quick inspection documented multiple perforations of the common femoral artery (CFA), superficial femoral artery (SFA), and common femoral vein (CFV) with profuse arterial and venous hemorrhage.After proximal clamp control of the left CFA was attained, your choice for management would besaphenous vein graft replacement of CFA/SFA, ligation CFV;intraluminal shunts to CFA/SFA and CFV;intraluminal shunt to CFA/SFA, ligation CFV;polytetrafluoroethylene (PTFE) graft replacement of CFA/SFA, ligation CFV.The injured segment of the left CFA/SFA was resected with sacrifice of the left profunda femoris artery, and a Pruitt-Inahara shunt (Lemaitre Vascular, Burlington, Massachusetts, USA) was inserted to restore arterial inflow to the lower extremity (figure 2). After the left CFV was ligated, the skin edges of the incision and defect in … ER -