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Sep 2021

Disembowelment: I'm hesitant to bold this term, because it is not really a thing. :joy: :joy: :joy:

Content warning: This explanation is extremely graphic and not for the faint of stomach.

So here's the rub, our internal organs are supported by a ridiculous amount of connective tissue. Ever dissected a human? Just me? Ok. :cry: Well, it's a pain to cut and remove all those layers of connective tissue to make the internal organs visible. While bullets and knives may puncture or slice through the intensities, stomach, liver, or kidneys, causing a whole host of problems, those organs are not going anywhere.

The closest thing to disembowelment that happens in real life is a rare, but honestly not very serious, medical condition called evisceration. Evisceration can occur in one of two ways: following surgery or very, very rarely due to high speed motor vehicle accidents. I'll explain each separately.

During abdominal surgery, surgeons will "clean up" connective tissue surrounding the intestines (called the mesentery) in order to better visualize the organs. Removal of the mesentery causes the intestines be floppy and free moving in the abdominal cavity. While mesentery grows back eventually, there is a period of time when the organs are vulnerable to "disembowelment". If the stitches or stables closing a surgical wound pull apart, then intestines can "spill out" of the abdominal cavity. However, they are still attached to the stomach and rectum, so they just chill out on your skin. It's pretty easy to fix and is not life threatening. You won't even bleed really, except maybe from the skin around the surgical entrance. But it looks horrific! Extreme content warning if you decide to google search that little treasure.

The second way evisceration happens is through high speed motor vehicle accidents. It is extremely rare, but the force of being thrown from a vehicle moving 60+ miles per hour can tear through or pull apart significant portions of the mesentery. Blunt trauma to the abdomen can then cause you to... er... defecate (do you know what that word means?) the bowel. If you see pictures online of the intestines coming out someone's butt, this is what happened. Lacerations or cutting trauma to the abdomen can also cause the guts to spill out through the opening, but this is only possible because the mesentery has been torn by high speeds putting high shearing pressure on the entire abdominal area at the same time. Guns and knives won't do this. Again, evisceration alone doesn't kill you, but blood loss and infection might.

Aaaaah Breezy thank you so much for sharing your knowledge on both these topics! The latter one especially I was struggling to find the correct info on, so I really appreciate you helping me out!

I hope I helped with whatever you were trying to write with the disemboweling scene. :joy: I got the impression you were going for war or accidental injuries? But maybe you were talking about torture? Please let me know if I can answer any other questions about sword, knife, arrow, or... idk blow torch wounds. :wink:

If you are talking about torture then... yeah, the bowels won't fall out on their own. But that doesn't mean it's not a valid form of torture. The torturer would just need to reach inside the incision in the abdomen and pull out the intestines, ripping through the mesentery. :dizzy_face: And then of course, pin the gut to the whipping post, making a horribly grotesque leash, which the person could only be free of if they gnawed through their own... ok I'm grossing myself out. :wink:

However, my horrific tangent got me thinking about your question of "how long until you're dead"? So, yeah, let's go with tortured guy with gut hanging out. He would most likely die from a combination of septic shock and hypovolemic shock.

Septic shock occurs when bacteria enters the blood stream (in this case from the open wound in your MC's abdomen). Usually, bacterial infections are localized. Think about what would happen if your finger was infected for example. It would swell, get red, and tender. This is because injury and chemicals released by bacterial activate the body's inflammatory response. Blood vessels local to the area of injury will dilate (or expand) and become "leaky", allowing water, white blood cells (which fight infections), and inflammatory molecules to enter the site of infection and do their work. However, when bacteria is in the blood stream, these same inflammatory molecules which tell blood vessels to expand and become porous travel throughout the entire body. This causes extremely low blood pressure (hypotension). Think about a water hose with not enough water pressure or too big of a opening. The water just sort of trickles through the tube. That's what happens in sepsis.
Because the body is not getting good blood flow, it doesn't get oxygen either (hypoxia). This is what causes death in septic shock. Between 4 to 48 hours from when the bacteria is first introduced into the blood stream, patients will begin to experience signs of sepsis which is characterized by low blood pressure, fast heart rate, decreased urine output, fever, and difficulty breathing. This will progress to loss of consciousness and injury to the heart due to lack of blood flow. Injury to the heart causes abnormal conduction of electricity through the muscles leading to poor contractions and eventually the heart will stop beating all together. And that's sepsis!
Hypovolemic shock is basically the same thing except the "water loss" is caused by dehydration or blood loss through a bleeding wound. A patient with an open wound in their abdomen would have both hypovolemic shock and septic shock at the same time. Both are "low volume states" in which the body does not have enough blood pumping enough oxygen to support body functions. The first places to be affected will always be non-vital organs such as the skin, kidneys, gut, etc, but eventually the heart and brain will be affected, which as I already said, leads to death.

We have about 5 L of blood, so how quickly a person will die just depends on how quickly they are bleeding out. For a person with a abdomen injury? It sort of depends on whether the person's abdominal aorta is cut. The aorta is such a high pressure system, it is difficult for blood to clot and stop the bleeding, plus you lose blood much faster. If it's cut via a very deep wound, I give them 10 minutes max. If it's not, I would give them 4-5 hours for the sepsis to kick in. Then, if they are not treated, maybe another 3-6 hours? No hard and fast rule here, it could be less than 30 minutes after sepsis sets in or the person could die from hypovolemic shock before they get to septic shock.

Oh, actually I was talking about a dude who's gonna commit suicide by ripping himself open and succesfully disembowels himself because he's a petty little shit. XD So this dude's got claws so he will try to perform the 'art' of it on himself. I'm writing a fantasy/horror with original species, but I want to be as believable as possible haha!

And oooooooh, okay! Now I very much appreciate this part, I was curious about the length and what could possibly happen in the meantime. My boy's definitely gone in 10 min, hands down haha!

Welp, not sure how you successfully made this forum ten times more horrific than when I mentioned torture, but ya did. Obviously you are well equipped for writing horror. 🤣

I have a question about a chapter I'm currently writing.

There's just been an earthquake, and one character's leg was crushed in a building collapse (this happens "off screen"). His friend is visiting him in the hospital right after he wakes up from surgery. Basically, I'm not sure how long to expect him to be in the hospital/how many additional surgeries he might need/what might be expected in terms of rehab. I also have very limited experience with being around someone as they wake up from anesthesia.

I've tried researching crush injuries, but I'm pretty squeamish and ran into some images I wish I hadn't seen, so this thread might be a good way to get around that :sweat_smile:

Thanks!

Thank you for this thread it's super interesting!

I'm currently writing the sequel of a book and, in that book, one of the characters is going to have cancer (starting by prostate cancer then it continues spreading). Any tips on how to make it more realistic and believable? From the symptoms before discovering he has cancer to his hospital stay? :slight_smile:

I am sort of excited about this post, but there is... a lot to unpack. For the sake of brevity I will try to give you a "path" for your character to follow. This is by no means exhaustive look at crush injuries, but rather a plausible scenario. I will mark timing with :watch: and "expect your character to" with :broken_heart: for easy reference. Keeping in mind you are squeamish, I kept all photo links very mild and hopefully shouldn't cause you any discomfort. So without further ado: Crush Injury

Treatment of crush injuries will depend upon resources available at a hospital. When we are looking at crush injuries caused by earthquakes, hundreds of people may be effected, putting strain on the local hospitals resources. I will side step this issue for the most part and tell you the "ideal" treatment, but when writing your story consider how the hospital, nurses, and doctors may be affected by a mass casualty event. What is the atmosphere like in the hospital? Tense, crowded, rushed?

Where resources are severely limited, limb amputation may be performed more frequently as amputating a limb takes WAY LESS resources and time than what I am about to describe. I am going to assume you want to save the leg, so here we go:

Surgery for crush injuries includes six parts, four of which are performed during the first surgery ideally within :watch: six hours of extraction of limb from rubble. 1) Infection Control: antibiotics are given through an intravenous catheter (IV). :broken_heart: Expect your character to be on IV antibiotics in the hospital for at least :watch: two weeks. The wound is then debrided of dirt, rubble, and necrotic (dead) tissue and irrigated with sterile water. 2) Prophylactic Fasciotomy: This is a procedure in which the skin, connective tissue, and muscle is sliced open with two incisions on the inner and outer lower leg. This is done in order to prevent the development of compartment syndrome which is when swelling within the limb puts pressure on the blood vessels and causes necrosis (death) of tissues. After surgery, :broken_heart: expect your patient to have these open wounds which would be covered with a suction device called a wound vac. I don't know how squeamish you are exactly, but I personally don't think this image3 is too disturbing and gives you a good idea of what this device looks like. 3) Fracture management: broken bones will be stabilized with rods and pins. External fixation devices are the most common for crushing injuries: meaning the leg is immobilized with metal pins sticking through the skin as seen here3. These devices can be removed without surgery after :watch: 6 weeks. 4) Revascularization: a specialized vascular surgeon (not the ER surgeon or orthopedic surgeon) will take a segment of the great saphenous vein from the uninjured leg to make an arterial graft for the affected leg in order to restore blood flow to the area. :broken_heart: Expect a 5 cm incision closed with staples on the character's inner shin of the unaffected limb which would have been used to extract the vein. Stables can be removed after :watch: 2 weeks. 5) Fasciotomy closure: :watch: Two weeks after injury, after swelling has gone down, the fasciotomy can be closed. A skin graft is taken from the thigh of the uninjured leg and used to close the wound. A wound vac is used to "suction" the wound closed and is removed after another :watch: two weeks. 6) Nerve repair: During the initial surgery, damage to the nerves will be noted and marked for later repair. A specialized neurosurgeon will perform nerve repair :watch: three to four weeks after injury. :broken_heart: Expect an incision closed with thin sutures along the back of the knee extending to the outer knee.

Wound care: Nonsurgical wounds will be covered with moist dressings which are "packed" into the crevices and valleys of the wound. Gauze is used to wrap the entire leg and keep dressings in place. Wounds are healed by secondary intention2 meaning from the bottom and outside to upwards and inwards. First granulation tissue (red, grainy tissue) fills in the open wound and builds up. It can take up to :watch: ten weeks for new skin (dermis) to begin to form. Dressings should be changed every :watch: twelve hours or more frequently if the wound is actively oozing/draining.

Ok, that concludes everything you should know about surgery and the wound itself. Now let's talk about the FUN STUFF! Everything else. :smiling_imp: I will now break down four common complications of crush injuries which are collectively aptly called crush syndrome and would most definitely affect your character.

Hyperkalemia: When muscle is damaged, cells rupture and release their contents into the blood stream. The first and most concerning molecule released into the blood stream is the electrolyte potassium. High potassium in the blood stream is called hyperkalemia. Large, rapid influxes of potassium can actually stop the heart (we use it during open heart surgery to stop the heart from beating with literally a spray bottle filled with the stuff). When a limb is trapped and all the blood vessels in that limb are compressed, all that potassium sits inside of the trapped limbs. But when you release that pressure, suddenly all that potassium rushes back straight into the heart. Hyperkalemia after crushing injuries can cause death within :watch: ten minutes due to cardiac arrest and is the primary reason we might choose to amputate the limb inside the field rather than free the limb (keeping all the potassium trapped inside the crushed portion), particularly in mass causality events such as an earthquake where resources are limited. However, we can also give massive amounts of fluids (2+ liters) through an IV to prevent cardiac arrest. Over the course of the next :watch: 48 hours hyperkalemia will be managed in the hospital to prevent irregular heart beats. Nurses administer insulin with dextrose (sugar) and calcium in order to push potassium into the cells and out of the blood stream. :broken_heart: Expect these medications to be administered to your character for at least :watch: two days along with their antibiotics through an IV pump. If hyperkalemia is severe enough, the patient will be placed on hemodialysis to clear the potassium from the blood, which I will explain in the next section.

Rhabdomyolysis: This occurs when protein from damaged muscles is released into the blood stream. (Fun fact, you can actually get rhabdomyolysis from drinking too many protein shakes so be careful!) Large protein molecules cannot be removed from the blood by the kidneys and can actually get trapped inside the small blood vessels of the kidneys, causing acute kidney injury. When this occurs we put patients on hemodialysis, which is basically an external system which pulls blood from the body, filters it, and then returns it to the body. The machine looks like this2 and you can :broken_heart: expect your character to be on this for at least :watch: three days while the kidney heals. Hemodialysis requires a specially trained ICU nurse to manage and we are in the room at least once an hour changing fluid bags and measuring input and output of fluids from the patient’s body. Blood is drawn from an IV at least every four hours to monitor electrolytes, kidney function, and other fun stuff I won't get into.

Sepsis is an infection of the blood and is commonly caused by large, open wounds. We give antibiotics to try to prevent this from occurring and to treat it, but it is still very common. The most dangerous symptom of sepsis is hypotension (low blood pressure). :broken_heart: Expect your character to be on at least two medications (levophed and vasopressin) to increase their blood pressure for at least 3-7 days. These medications are given through a special, very large IV inserted into the neck as seen here1. Sepsis also causes water from the blood to leak into the surrounding tissues. This is a big problem when the water leaks into the lungs in a condition known as flash pulmonary edema which leads to:

Acute respiratory distress syndrome: FINALLY I am ready to talk about "waking up" after surgery! Sort of. :sweat_smile: During surgery :broken_heart: your character will be intubated which is when a breathing tube is inserted through the mouth into the trachea and a machine called a ventilator breathes for them. With minor surgeries, the tube is immediately removed. This will not be the case with your character, because they will have respiratory complications (fluid in the lungs) related to crush syndrome. :broken_heart: Expect your character to be intubated after they are out of surgery as seen here4 for at least :watch: three days, but actually more like a week or more. :broken_heart: Expect your character to be in a medically induced coma for most of that time with at least 1-2 sedative medications on board (my favorite is propofol; it's the one that is white colored and Michael Jackson overdosed on). :broken_heart: During this time your character will have a urinary catheter2 draining their urine and a feeding tube1 giving them liquid food.

Waking up and Extubation: Coming out of sedation and off the ventilator is a process! We slowly wean the patient off the ventilator by decreasing the amount of oxygen or "support" the patient is receiving (basically how much work the ventilator is doing compared to the patient's own breathing effort). At the same time we wean them off sedation. People who are intubated and confused may try to rip the tube out of their mouth as they are coming off sedatives, so we restrain them with soft wrist restraints1. This can be distressing and disorientating when your character first wakes up. :broken_heart: Expect gagging on the tube, biting, and a bit of trashing. :broken_heart: Expect the nurse to frequently remind your character that they are in the hospital, that they are being treated for an injury to their foot, and that they have a tube in their mouth that is breathing for them. The nurse will also encourage friends and family members to talk with the patient to reassure them and calm them down. During this time, :broken_heart: your character may attempt to communicate by mouthing words, using their phone, or writing on a sheet of paper (although their hand is usually shaky and the hand writing can be atrocious). Most nurses can identify simple words around the breathing tube such as, "bathroom", "water", "pain", "cold", or "insert-family-member-name-here". (Note, if they ask for water, we can moisten their mouth with a wet sponge). It is normal to increase sedation if the patient is anxious to put them back to sleep and then try to decrease it again the next day. :broken_heart: Expect the nurse to turn off sedation completely for about 2-3 hours everyday for :watch: three days while the respiratory therapist turns off all support from the ventilator to see if the patient "flies". Once the patient is able to breath on their own with sedation completely off, the respiratory therapist will remove the tube (extubate the patient) and put the patient on supplemental oxygen, usually with a nasal cannula2. :broken_heart: Expect your character to not have a voice for about :watch: 2-3 hours and then a horse for another day. Most young, healthy patients are completely "there" mentally by the time the tube is removed and they are very happy when it is finally taken out. At this time the feeding tube and urinary catheter can be removed. :broken_heart: Expect your character to complain about being thirsty and for the nurses to give them ice chips first and then slow sips of water. Food is reintroduced slowly with liquids (juices and jello) first and then soft foods the next day and finally regular food on the third day.

Long Term Recovery: As soon as a patient is off the ventilator (:watch: day three to seven), physical therapy begins working with the patient in the hospital. They will focus on upper body strength and movement of the unaffected limb. Remember the affected leg must be immobilized with no weight on it for :watch: six weeks. :broken_heart: Expect your character to be discharged from the hospital (assuming their is literally ZERO complications) :watch: about a month after initial injury (about one week after nerve repair surgery). All wound vacs will be removed at this time and your character will be instructed on how to clean and dress their own wounds (with water only, wet to dry dressing as described above). They will continue to go to physical therapy 2-3 times per week at a outpatient treatment center1. About :watch: two weeks after injury your character can have his external fixator device removed and the physical therapist will begin working on rebuilding leg strength. :watch: Ten weeks after the injury, expect new skin growth and scar formation. The patient can now clean all wounds (surgical and traumatic) with mild soap and should continue watching for signs of infection. :watch: Three to four months after injury (after 6-12 weeks of physical therapy) :broken_heart: expect your character to have close to full use of his leg with lingering pain, numbness, scars, and possible weakness.

Thanks for bearing with me through ALL THAT!!! I'm sure it was WAY MORE than you thought or wanted. Yeah, crush injuries are complicated and take a long time to recover from! Happy writing! :heart_eyes:

HI!! You are amazing!! My comic delves into gore sometimes, so I definitely have a few questions. (these are the ones I can think of.... i probably have more....)

  1. Not sure if you've got experience with this, but what does an assault rifle shot do to the body? How is an assault rifle shot injury different from other guns, and how does the power of it affect the injuries?

  2. let's say you have metal wires that have been heated to the point of being impossible to touch without a severe burn. What would happen if you tied up a person with these wires? How would the skin react, how much blood would there be, what would the scars look like?

  3. another burn one. what would happen if a person held onto these wires with their hands, and what medical treatment would be necessary for the burns? What would their hands and skin look like after the treatment? Would they have any mobility issues in their fingers?

  4. what does a limb amputation look like, if there is an injury to the limb so severe that the only option is amputation? The amputation would occur further up the limb from where the injury is, so the process would not involve the previous injury. If i am drawing this in a very simplistic style, what should my drawing prioritize? How much of the bone would you see, what tools are being used, what basic color is the tissue and blood?

  5. bonus: what do you believe is the most painful injury? I need some shock value planning, lol!

Again, thank you so so much. I've been hoping for a resource like this!! Google is never very helpful. Feel free to not answer the ones you don't have experience on. I'd be happy with ant input you can offer! :DD

errrrrr... sorry? :cry: I would love some feedback on what you thought was gross about that particular explanation. My sense of what other people find disgusting is off I guess... Maybe this could help me tone down later entries?

This thread is amazing :0
I've been lurking and reading everything like :eyes::eyes:

I have a question about meningitis and limb loss

I have a character (not in my comic) that had to have her leg amputated when she got complications from meningitis as a baby/toddler (not sure on age)

I tried looking up meningitis complications and from what I saw, it was usually pairs of limbs or sometimes all four limbs had to get amputated, so I'm wondering would it be realistic if one limb got amputated?

No no, you're fine! I'm just super squeamish, but I meant it more jokingly than as a complaint. You did a great job of making something extremely unpleasant readable.

Ooooo! Finally a medical disease rather than all these injuries! BAHAHAHAHA! :joy: Content warning for all pictures (may include some... ya know, prostate stuff).

Prostate cancer: Ok, first off, cancer usually has zero symptoms during its early stages. That's why we screen for prostate cancer every two years in men over the age of 55 (or earlier and more frequently if a patient has a brother, father, or uncle with prostate cancer). Screening is done by drawing blood to check for prostate-specific antigen (PSA) levels. For this reason, prostate cancer has a 98% survival rate even though it is the most common form of cancer in men worldwide! Hurray for us! :smile: However, at time of diagnosis up to 6% of people can have metastases (spreading) of the cancer to other parts of the body. If your character is from a low-income household or does not have insurance, he may fall into this category making survival less likely. :sweat:

Although most people will not have any symptoms at first, they may have blood in the urine or semen, difficulty starting their urine stream, feelings of needing to pee constantly, double urine stream, drippling in their underwear, trickling urine stream, or erectile dysfunction. However, many older men (especially men who will later develop prostate cancer) have benign prostatic hyperplasia which is has many of the same symptoms, so they may not think much of it. Other symptoms are similarly nonspecific to cancer, such as weight loss and fatigue. If your character has metastasis, the most common location is to the bone, which will result in bone pain at the time of presentation in the legs or back.

Diagnosis is confirmed by taking a biopsy of the prostate. Biopsy is guided by magnetic resonance imaging (MRI) through the rectum and does not require anesthesia. Bone metastasis is detected with a separate imaging procedure called radionuclide bone scan as seen here. Hope you aren't claustrophobic!

Prostate cancer is diagnosed and treated almost always in the outpatient setting (meaning no hospitalization required unless we are talking SUPER advanced stages). Initial treatment for prostate cancer is external beam radiation therapy with brachytherapy which is... crazy. Basically we insert these needles into the prostate that emit radiation. Crazy enough, most people are not sedated for this procedure either. We do it with epidurals or conscious sedation with local lidocaine. Here's a picture for my freaks that are curious what this looks like. You can go home the same day after anesthesia wears off.

For advanced stages of cancer that have spread to the lymph nodes we use androgen deprivation therapy (ADT) which basically stops the production of testosterone and halts the spread of the disease. You character would go to his oncologist ever month to get an injection in his butt for 18-24 months. (If you want a fast death, prostate cancer ain't it.) Side effects of this medication include hot flashes, mood swings, weight gain, erectile dysfunction, and loss of bone density leady to pathological fractures.

Chemotherapy can be used in addition to ADT. Chemotherapy is given in a cancer center every three weeks using a indwelling catheter which looks like this. I'm just kidding. :smile: There is usually no smiley face. Here is a diagram Your MC will take oral steroids (prednisone) for three days before going to their schedule appointment. The nurse will access the catheter using a special needle and the chemotherapy is infused over one hour. Side effects of chemotherapy are well known (hair loss, vomiting, immune suppression leading to infections).

So let's talk about what's gonna (maybe?) kill you: metastases to the bone. So this is really painful, so controlling pain is an important part of management. We use a combination NSAIDs like ibprofen and morphine for pain control. Bone-targeted radiation therapy is always first choice. Then we use drugs called osteoclast inhibitors to restore/preserve bone density and prevent pathological fractures (which is where the bone is so thin it breaks without any trauma). This medication is self-administered using a very small needle loaded into an autoinjector which you push against the fatty part of the stomach to inject every month. Don't forget to take your vitamins (calcium and vitamin D)!

Ok... so I'm really trying here to research how people die from prostate cancer and it's like... not a thing. :joy: If it happens it is a SLOW death, caused by medical complications related to the disease, not the cancer itself. I'm remembering this cancer patient I took care of last week who the doctor was explaining to the family that it "wasn't the cancer" that was killing him. There are hundreds of complications that could happen during your treatment that could lead to hospitalization or death, so I will try my best to give you a possible scenario:

If you had a pathological fracture to the hip or vertebral bone (spine), you would need surgery to repair it. This is what's gonna get you into the hospital and start your decline. Cancer patients don't do well in surgery, because they are immunocompromised (meaning their immune systems are weak). The surgical site could get infected and spread to the blood causing sepsis. I've explained this in other posts already, but in brief sepsis causes low blood pressure which leads to the body not getting enough oxygen which leads to the heart not getting enough oxygen which leads to cardiac death.
The patient could get a lower respiratory tract infection caused by bacteria being introduced into the lungs via artificial airways (i.e. a breathing tube). This is called ventilator associated pneumonia. Pneumonia can scar the lungs, making them "stiff" and noncompliant. Eventually this will lead to respiratory failure which will lead to low oxygen content in the blood which will lead to cardiac death.

And there you have it!

Thank you. :heart_eyes:

Short answer: absolutely!

Semi-short answer (I'm gonna try this time, I promise):
Meningitis is very rare these days because we have vaccines! Hurray! Some virus that we don't cover with vaccines can cause meningitis, but the disease is very mild and never causes lose of limbs. Amputation of limbs is pretty specific to Meningococcal Meningitis, which we vaccinate for at age 11.

So, you're MC is super unlucky, maybe hanging out with someone who isn't vaccinated as a baby. The younger the better :smiling_imp: cough cough I mean worse. Meningitis is a disease of the brain's supportive tissues or "lining" and by itself does not cause the need for amputation. Long term complications of meningitis which may affect your MC in their adult life include seizures, hearing loss, and intellectual disability or behavioral problems.

So where does this leg amputation come in? Well, very rarely the bacteria (meningococcal) can travel into the blood stream. I've talked about sepsis on this thread before, but there is a complication of sepsis I haven't talked about yet called disseminated intravascular coagulation (DIC). Basically what happens is that bacteria binds to the lining of your blood vessels and releases a molecule called ADAM10, which prevents the body from being able to stop clotting. Clots of blood will form randomly in small blood vessels, and when they grow big enough to occlude the vessel completely it is called thrombosis. Thrombi that form in the arterial system of the leg lead to ischemia (damage to tissue due to lack of blood flow) which leads to necrosis (death of tissue) which leads to, drum roll please, amputation.

This is pretty random where it happens and can totally affect just one leg, but if a baby was sick enough for it to happen in the first place they would be hospitalized and a good or really just average doctor would recognize a thrombi had formed way before it led to necrosis and amputation... but idk what kind of setting or access to healthcare your MC has. Sadly, lots of people don't have good access to healthcare and maybe they aren't getting good treatment. That thought successfully made me super depressed. :cry:

phew. :sweat_smile: I'm glad I didn't misjudge that. Happy writing!

Errrrr.... I unfortunately have not vicariously experienced all people's suffering and everyone's pain tolerance is different, so I have no idea. But... this is fun to speculate about something I'm totally not qualified to.

I hear broken femurs hurt a lot, but I personally think that pain alone isn't what makes something unbearable. It's the discomfort, associated symptoms, the lengths we go to treat the condition that make this truly unbearable. Burns check those boxes pretty well. Like, dressing changes on burns: shutter. Plus they aren't just painful, they are tingling and horrific to look at. They come with a whole host of medical complications I've explained in other threads that add to a person's discomfort. What else, what else. Removing the finger nail or tooth. That would hurt and be psychologically horrifying, which adds to our perceived pain. Ok, that's all I've got for you there.

Are you talking about the surgery? Honestly, I could explain this, but it might be more helpful for you as an artist to just watch a video if you have a steal stomach. SUPER EXTREME CONTENT WARNING! :dizzy_face: SERIOUSLY DON'T CLICK WITHOUT THNKING TWICE.

Of course! Basically anything necrotic (dead) will always need to be amputated. Necrosis is usually caused by either lack of blood flow to the area (see crush injuries above although there are lots of ways this can happen) or by an infection called necrotizing fasciitis, which if you want some horror: this is it! The cream of the crop, this condition is also called "flesh eating disease". It can honestly happen with a wound of any severity that is not kept clean, but the bigger the wound, obviously the more likely it is to get infected. Also, lightning can cause necrosis of the leg and require amputation. So if you've got some nifty lightning magic? Wiggle eyebrow suggestively.

No blood. The burn would of course create a pattern in the shape of the metal wires. The skin would first become red, then blister, then sluff to reveal the fat, then muscle, then bone. The area around the burn would be red and swollen. The wound bed (center where the wires are touching) would be multicolored with black necrotic debris, white bone, red muscle, and yellow fat showing in irregular, grotesque patterns. The scars would be red and linear with uneven texture and would become lighter (lighter even than the original skin called depigmented) over years.