BERAM Flap to the Rescue; Perioperative Journey from ER to OR to Recovery in a Three‑year‑old Child having Type 3c Compound Fracture with Vascular Involvement

Abstract

Systematic approach to a paediatric trauma victim who has sustained life threatening injuries calls for good pre‑hospital care, triaging in the emergency room and effective management consisting of primary survey along with skilled resuscitation followed by secondary survey. After stabilization, it is essential to know the severity of injury and soft tissue defect by vigilant clinical examination, coupled with assessment by established scoring systems, such as GANGA and MESS, in order to plan further management. Recent guidelines in polytrauma management stress on initial damage control surgery for achieving haemostasis and debridement, followed by definitive reconstructive procedure. The procedure involves essential management of type 3c compound fracture with vascular involvement by damage control surgery along with vascular repair by saphenous graft followed by unique method of BERAM flap in continuity with Lattismus dorsi myocutaneous flap subsequently. Because of its role in hemodynamic stability and regional blood flow, anaesthesia is an important determining factor in the success of microvascular free flap surgeries. Stabilizing haemodynamic and achieving normal metabolic and biochemical parameters is essential. Our case report is aimed at reviewing the relevant aspects of anaesthetic practice in a procedure involving microvascular flaps.