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29-APRIL-2009  AHMAD RIYAD AL-HEAT  24 YEARS  WOUND DEHISCENCE AFTER EXPLORATION OF THE CAUDA EQUINA 10 DAYS AFTER WITH CSF LEAK.

Anamnesis:

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The patient was operated by me 10 days ago for gun soot shrapnels in the cauda equina. The patient start to show some improvement of the left lower limb, but wound dehiscence took place and CSF leak started to escalate.

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The wound was opened and the Tachyseal completely disappeared and the surgicel was in the lower corner of the wound. The CSF was coming from the left side from where the previous big shrapnel was removed, which was locating extra and intradural.  There is no dura to repair. The bony defect was extended slightly up and the looking healthy dura was opened and external drain was inserted about 10 cm above the wound and the xanthochromic CSF came through it. It was directed to the right side 20 cm away from the midline. To avoid using artificial elements, the paraspinal muscles were dissected, so that a layer was created to cover the scarrous running rootlets. The meticulous water-tight closure of the wound was achieved.

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The back slap of the right lower limb was changed.

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Smooth postoperative recovery with the external drain attached to its external part for draining and daily delivery of gentamicine, papaverine and Marcain 0.5.

Comments

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This case showing the disappearance of Tachyseal and its useless role and the reaction to foreign bodies such as these artificial materials. Using his own paraspinal muscles, reflected as flap is the only option remaining in this case.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.


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Notice: Head injuries and very urgent surgeries are also escaped from the plan .

     

  

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