1. BallerGamer
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    BallerGamer Active Member

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    Amputation?

    Discussion in 'Plot Development' started by BallerGamer, Jun 7, 2012.

    One of my characters has a severely broken leg that is basically dead and needs to be amputated. But, thanks to the nature of my world his leg can be cured, only as long as it isn't severed. Though this type of surgery requires a lot of money and the character's family is trying to save up to get it. The problem is that if the leg remains there, risks of death have come up. I couldn't find this anywhere (immediately) and I feel it's too small of a question that I should spend significant time on researching, but how long before the leg does serious damage to the body if it's not amputated? Sorry if I sound lazy but I just hate it when I have to research deeply into things like these. The specifics of the injury is that this large monster basically grabbed onto his leg and crushed it.

    Any help is appreciated!
     
  2. Trilby
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    Trilby Contributing Member Contributor

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    I imagine that if the leg is not infected (no broken skin, cuts or grazes) then time is of no consequence, the leg would heal its self no matter how distorted it may be.

    If it is infected, then depending on the medication available 'in your world' they could die in the matter of days/weeks.
     
  3. Cogito
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    Cogito Former Mod, Retired Supporter Contributor

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    The body is teeming with bacteria and viruses. Only living flesh with a good circulatory system can resist attack by microorganisms.

    Gangrene sets in quickly if the flesh is dead, and produces lethal toxins that can quickly spread to healthy flesh and organs. Even partially dead flesh is vulnerable, and can lead to necrotizing fasciitis, commonly known as flesh-eating bacterial infections, which are rapidly deadly.

    These are conditions that can be lethal within days, even hours.
     
  4. killbill
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    killbill Contributing Member

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    Cog is right but I think gangrene can be prevented or at least delayed for a considerable duration by using injectable serums like AGG (antigas gangrene). However, doctors take no chances and do the amputation as soon as possible, at least in this part of the world where I live.
     
  5. BallerGamer
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    BallerGamer Active Member

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    Thanks guys that really helped! I didn't know the timetable would be this soon for my character, was hoping it could have been for at least a month, although knowing what happens to rotten flesh still attached to the body now that's a foolish notion. Although I could work around the circumstances by what killbill talked about, in fact that may actually strengthen this particular scenario.

    Much appreciated!
     
  6. psychotick
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    psychotick Contributing Member Contributor

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    Hi,

    There are two things that are absolutely critical in keeping the leg alive, and the victim. The first is blood flow. Blood carries oxygen and takes away waste products. Without it the leg tisue would begin dying within hours. So if arteries and veins have been severed or crushed as I imagine they would have been, they need to be surgically repaired quickly if the leg is to be saved. The second is infection. Blood carries antibodies and other infection fighting cells, but in cases of severe injury, especially from a germ ridden bite, this is not enough. He needs antibiotics. High dose, broad spectrum and IV initially. The upshot is that he's going to be in a hospital bed for some time.

    After that things like nerves for the functioning of the leg, bones, muscles and tendons need to be repaired. Again this is surgical and should probably be done ASAP. And once the repair is done he'd likely be in a cast for a good long time. Idon't know what the medical tech is in your world, but you need to consider all of these things.

    My thought would be that if he had been through all this initial surgery and is up and running around in a full leg cast, he may still have problems. The infection may still not be completely under control, and some staphs and streps could be producing toxins that are eating away at his tissue. They will also cause him fevers and maybe worse - fits, fainting, argues etc. Also if the wound is still festering, it may need to be regularly debrided, i.e the dead tissue needs to be regularly cut away, and piece by piece he could be losing his leg anyway.

    Equally the blood flow to his arteries, toes, leg, veins etc, may not be completely perfect. Maybe it was not possible to do a 100% repair. This would lead to tissue necrosis, likely starting in the pieces of the leg, often the toes, that are not receiving sufficient blood supply. These bits would likely be quite blue, would need to be inspected regaularly, and would likely be getting some sort of intense physio at least daily to help keep the blood flowing.

    Maybe it is these things that your advanced med tech could deal with and which cost so much.

    Cheers, Greg.
     
  7. BFGuru
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    BFGuru Active Member

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    As the tissue dies (assuming circulation is compromised) it will become swollen. That limb will be larger than the other limb. You may even press your fingers into the swollen skin and a blanched dent will remain. The skin will start to turn red. Pain will start to set in as infection begins to overtake the limb. You have some time to treat with antibiotics at this stage. The tissue will begin to die. The skin will start to blacken in spots, normally starting at the most distal point (aka toes in the foot). The redness and swelling will start to spread. If one were to take a pen and mark the borders where the red skin and healthy skin meet, you may see the redness pass the ink. The patient will start to run a fever, and his vitals will increase. His heart rate will increase and his breathing may become shallow. At this point sepsis has set in and you've got hours to days to treat.

    The tissue may be debrided. The surgeon (here) will remove all the dead tissue. The patient will be pumped full of antibiotics and may even have complications due to how intense the antibiotics are killing off even healthy bacteria. C-diff is a complication of the antibiotics. It brings major gastrointestinal upset. Fungal infections are also common with major antibiotics.

    How your world will save the limb is up to you, but we do have the capability to save limbs here. The question is how much scawrring and how much rehabilitation therapy is needed post op.
     
  8. BallerGamer
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    BallerGamer Active Member

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    The past two posts have provided me great knowledge on what I needed to know and I thank you deeply for the help, cheers! :D
     
  9. AmyHolt
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    AmyHolt Contributing Member

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    The information given so far is great and I don't really have anything to offer in that area, my only thought is that sometimes when vessels are cut they will sometimes use leeches to get the blood flowing again (it's called leeching) anyway it sounds like something a family might try in the situation you described and could add some interest to the situation because it's gross.:0
     

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