The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization
- Author:
Jagdish Krishnan
;
M Paiman
;
AS Nawfar
;
MI Yusof
;
W Zulmi
;
WS Azman
;
AS Halim
;
AZ Mat Saad
;
MD Shafei
;
WI Faisham
- Publication Type:Journal Article
- MeSH:
Extremities
- From:Malaysian Orthopaedic Journal
2014;8(1):14-20
- CountryMalaysia
- Language:English
-
Abstract:
A seven years retrospective study was performed in 45
consecutive vascular injuries in the extremities to investigate
the pattern of injuries, managements and outcomes.
Motor-vehicle accidents were the leading cause of injuries
(80%), followed by industrial injuries (11.1%) and iatrogenic
injuries (4.4%). Popliteal and brachial artery injuries were
commonly involved (20%). Fifteen (33.3%) patients had
fractures, dislocation or fracture dislocation around the knee
joint and 6 (13.3%) patients had soft tissue injuries without
fracture. Traumatic arterial transection accounted for 34
(75.6%) cases, followed by laceration in 7 (15.6%) and 9
(6.7%) contusions. Associated nerve injuries were seen in 8
(17.8 %) patients using intra-operative findings as the gold
standard, both conventional angiogram (CA) and
computerized tomography angiogram (CTA) had 100%
specificity and 100% sensitivity in determining the site of
arterial injuries.
The mean ischemic time was 25.31 hours (4 - 278 hours).
Thirty-three (73.3 %) patients were treated more than 6
hours after injury and 6 patients underwent revascularization
after 24 hours; all had good collateral circulation without
distal pulses or evidence of ischemic neurological deficit.
The mean ischemic time in 39 patients who underwent
revascularization within 24 hours was 13.2 hours. Delayed
amputation was performed in 5 patients (11.1%). Of the 6
patients who underwent delayed revascularization, one
patient had early amputation, one -had delayed amputation
following infection and multiple flap procedures while the
rest of the patients’ limbs survived. Joint stiffness was noted
in 10 patients (22.2%) involving the knee joint, elbow and
shoulder in two patients each. Infection was also noted in 5
patients (11.1%) with two of them were due to infected
implants. Other complications encountered included nonunion
(2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1
patient, 2.2%) and leaking anastomosis in one patient
(2.2%). Volkmann’s ischemic contracture occurred in 3
(6.7%) patients. There was no complication noted in 8
(17.8%) patients Three patients (6.7%) died of whom two
were not due to vascular causes. We conclude that early
detection and revascularization of traumatic vascular injuries
is important but delayed revascularization also produced
acceptable results
- Full text:P020150522582848738193.pdf
