Management of vascular injuries to the leg (original) (raw)
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Treatment of vascular injuries associated with limb fractures
Annals of The Royal College of Surgeons of England, 2005
INTRODUCTION The goal of therapy in all patients with combined orthopaedic and vascular injuries of the extremities is salvage of a functional limb. In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture.
Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates
The American surgeon, 1984
A 3-year clinical experience is analyzed to define preferred surgical management and amputation rates for popliteal as well as infrapopliteal arterial injuries. Ten patients with popliteal arterial trauma were successfully managed without amputation, however, five of 11 (45%) patients with infrapopliteal arterial trauma required amputation. While essentially all popliteal arterial injuries mandate repair, recommendations for repair or ligation of isolated tibial arterial injuries are based on presence of distal ischemia, the patient's associated injuries, as well as estimated operating time for reconstruction. With injury to two or three infrapopliteal arteries, distal ischemia is usually present and arterial repair indicated, unless there has been severe crush injury, prolonged delay, or extended surgery would jeopardize the patient's life. A management protocol for patients with distal ischemia related to popliteal or infrapopliteal arterial trauma should include prompt su...
European Journal of Vascular and Endovascular Surgery, 1995
Objectives: Review of limb arterial injuries associated with limb fractures. Design: Retrospective study. Setting: University Hospital. Materials and Methods: The clinical presentation, assessment and management of 25 patients with upper (seven) and lower (18) limb arterial injuries associated with limb bone fractures has been retrospectively reviewed. Main Results: Five patients presented with life threatening injuries and classic signs of acute limb ischaemia, 15 patients had an obvious limb arterial injury, and 5 presented with a suspected limb arterial injury. The site of arterial damage was: superficial femoral (4); popliteal (11); tibioperoneal trunk (3); anterior tibial (4); posterior tibial (3); peroneal (2); axillary (1); brachial (5); radial (4); and ulnar artery (4). The types of arterial repair were: autogenous vein interposition or bypass grafting (17); P.T.F.E. (2); end-to-end anastomosis (14); and Iigation (8). The popliteal vein was injured in six cases, repaired in four and Iigated in two; the superficial femoral vein was injured in four cases, repaired in three and ligated in one; and the axillary vein was injured in one case and was ligated. Primary nerve repair was employed in six out of seven injured nerves. Skeletal fixation preceded vascular repair in 21 patients and in four a Javid shunt was used. Intraoperative fasciotomy was performed in 12 out of 18 patients with lower limb ischaemia. Completion arteriography revealed residual thrombi in the distal foot of four patients, in whom intraarterial thrombolysis was effective. During the follow-up period of 1.5 to 2 years, the upper and lower limb preservation rate was 100 and 89%, respectively. The upper limb function was judged excellent in five patients, good in one and fair in one. In the lower limbs it was excellent in 11 patients, good in three, fair in one and poor in one. Conclusions: To ensure life and functional limb salvage of patients with devastating vascular injuries, a well organised multidisciplinary approach is necessary.
Vojnosanitetski pregled, 2016
Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstructio...
Management of combined femoral artery and vein injuries
Objectives: The aim of this study was to review our experience with combined injuries to the femoral artery and vein, and to analyze the role of venous repair. Methodology: Thirty two patients with penetrating injuries of the both femoral artery and vein underwent surgical management at our hospital from May 1999 to August 2009. Primaryxvascular repair was carried out whenever possible; if not possible the interposition graft was used. Results: This study group consisted of 27 males and 5 females, ranging in age from 15 to 72 years with a mean age of 28.3 years. The mechanism of injury included gunshot wounds in 18 patients and stab wounds in 14 patients. Primary arterial repair was performed in 17 patients. Autogenous saphenous vein graft was used in nine patients and vein patch in two patients. Polytetraflouroethylene (PTFE) graft was used in four patients. All patients had associated venous injuries of which 24 patients had primary venous repair, five had vein graft interposition...
Complications of operative treatment of injuries of peripheral arteries
Cardiovascular Surgery, 2000
In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3.77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).
Management of Combined Vascular-Orthopedic Limb Injuries
Background Vascular injuries combined with fractures and/or dislocations are associated with a high rate of limb amputation. The aim of this prospective study conducted in Ghazi Al-Hariri Surgical Hospital, Baghdad, Iraq was to assess the surgical management of these injuries in this tertiary center.
Role of Liberal Primary Fasciotomy in Traumatic Vascular Injury
Trauma Monthly, 2012
We believe that this article will help in the management of post-traumatic and post-firearm vascular injuries. Background: Vascular injury represents less than 1% of all injuries, but deserves special attention because of its severe complications. Amputation or retention of a painful functionless limb is the most untoward result of severe vascular injury or inadequate treatmet. Thus, vascular injury needs a judicious and multidimensional approach. Objectives: This retrospective study was done to asess the outcome of minor modifications of the methodology of extremity fasciotomy by making it liberal with respect to incision and definition. Materials and Methods: Out of 55 patients in 2008, 45 patients (Group A) had either no fasciotomy or limited primary fasciotomy, 10 patients (Group B) had primary liberal fasciotomy. Another group from 2008 onwards had undergone primary liberal fasciotomy in all the 45 patients (Group C). Results: In group A, we had 5 amputations and one death. In group B, there were no amputations or deaths and from group C, we had one amputation and no deaths. Conclusions: Blunt and distal traumatic vascular injury of the extremities and its repair should always combined with primary liberal fasciotomy, which although increases manageable morbidity, avoids disability (functional as well as anatomical).