A stab wound to the leg is a severe medical emergency, primarily due to the presence of major blood vessels like the femoral artery and vein, which can lead to life-threatening blood loss. Recognizing the gravity of the situation is paramount, requiring the immediate activation of the emergency medical system by calling 911 or the local emergency number. Professional medical help is required before any attempt at direct intervention.
Immediate Pre-Hospital Steps
The initial response involves ensuring the immediate environment is safe for the rescuer and the injured person. Once the scene is secure, instruct the injured person to lie down to minimize movement and reduce the heart rate, which helps slow blood loss.
The leg should be exposed by carefully cutting away clothing to assess the injury’s severity and location. Keep the leg still to avoid exacerbating internal damage. Elevating the leg slightly above the heart can sometimes reduce blood pressure at the wound site, provided this does not cause additional pain or move an impaled object.
Managing Severe Bleeding and Impalement
Controlling severe hemorrhage is the most immediate priority. If no object is impaled, apply immediate, firm, and continuous direct pressure to the wound using a clean cloth or sterile gauze. Maintain direct pressure without interruption to allow clotting mechanisms to begin working.
If an object is still embedded, it must never be removed, as it may be blocking a severed blood vessel. Removing it can lead to immediate, massive, and potentially fatal hemorrhage. Instead, stabilize the impaled object in place using bulky dressings or clean towels stacked around the entry site. Stabilization prevents the object from moving and causing more internal damage during transport.
If direct pressure fails to control severe or pulsating bleeding, a tourniquet must be used as a life-saving measure. Apply a commercial tourniquet two to three inches above the wound, placing it between the wound and the torso, and never directly over a joint. The device must be tightened until the life-threatening bleeding stops completely; this is necessary to prevent death from exsanguination. If a single tourniquet is insufficient, apply a second one immediately above the first, closer to the hip. Note the time the tourniquet was applied clearly for medical personnel.
Professional Medical Intervention
Upon arrival at the hospital, the medical team performs a rapid assessment, looking for “hard signs” of vascular injury like pulsatile bleeding or an absent distal pulse. For stable patients, imaging is utilized to determine the depth of the wound and identify underlying damage.
Computed tomography (CT) scans, often combined with angiography (CTA), are the primary diagnostic tools to visualize the integrity of major arteries and veins. This imaging helps surgeons pinpoint vascular injuries, such as a tear or transection of the femoral or popliteal artery, which carry a high risk of limb loss.
Intervention also includes initiating infection prophylaxis, typically involving a tetanus shot and administering broad-spectrum antibiotics. Definitive treatment often requires surgical exploration to clean the wound, inspect for damaged nerves or tendons, and repair compromised vessels. Repairing a severed artery is necessary to restore blood flow and prevent tissue death in the lower leg and foot.
Recovery and Monitoring for Complications
Following successful treatment, recovery begins with diligent wound care instructions after discharge. This includes keeping the surgical site clean and dry, monitoring for signs of localized infection such as increased redness or swelling, and adhering to prescribed antibiotics.
If the wound damaged muscles or nerves, physical therapy and rehabilitation are often necessary to regain full strength and range of motion. Careful monitoring at home is important for several weeks due to potential delayed complications.
Deep Vein Thrombosis (DVT)
One serious concern is the development of deep vein thrombosis (DVT), a blood clot in a deep vein, resulting from trauma or prolonged immobility. Symptoms include new or worsening pain, warmth, and swelling in the leg. DVT carries the risk of a pulmonary embolism if the clot travels to the lungs.
Acute Compartment Syndrome
Another complication is acute compartment syndrome, where swelling or bleeding within the muscle compartments creates excessive pressure. This pressure can lead to irreversible muscle and nerve damage. Persistent numbness, tingling, or pain disproportionate to the injury should prompt immediate medical re-evaluation.