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
Extremities

Introduction: The number of unvaccinated children and the rate of vaccination refusal among parents have recently increased despite the robust vaccination programme in Malaysia. The purpose of this study was to determine the level of knowledge of the Malaysian National Immunisation Programme among Malaysian parents as well as the variables that contribute to poor knowledge. Methods: This study used systematic random sampling to recruit 375 parents from seven health clinics in the Dungun District of Malaysia. The participants were asked to complete a self-administered validated questionnaire that included sociodemographic and knowledge questions. A multiple logistic regression analysis was applied to determine the associated factors of poor knowledge of immunisation. P-values of <0.05 were considered statistically significant. Results: A total of 189 (50.4%) respondents had poor knowledge of immunisation. The multiple logistic regression analyses revealed that a low educational level (adjusted odds ratio (OR): 1.92; 95% CI 1.25–2.95) was associated with poor knowledge while the age-group of 30-40 years old (adjusted OR: 0.56; 95% CI 0.34–0.93) was protected against it as compared to the age-group of <30 years old. Conclusion The prevalence of poor knowledge of immunisation among parents in Dungun, Terengganu, is relatively high. The focus of health promotion and education must be switched to increasing immunisation knowledge among the public, particularly among high-risk groups.
Knowledge ; Immunization ; Malaysia