Lower extremity vascular injury


Authors: Jana Pometlová 1;  Leopold Pleva+ 1 3;  Vladimír Ječmínek 1;  Jana Chmelová 2
Authors‘ workplace: Traumacentrum FN Ostrava-Poruba, 2RTG pracoviště FN Ostrava-Poruba, 3Lékařská fakulta OU
Published in: Úraz chir. 20., 2012, č.2

Overview

INTRODUCTION:
Fractures of lower limbs with arterial injuries are among the serious, complex wounds. They require rapid diagnosis and therapy to stop bleeding and reduce irreversible ischaemia of soft tissues which may cause subsequent amputation. Despite the possibility of improving surgical and endovascular treatment, these injuries remain a high morbidity. Remain unclear, some issues such as initial treatment procedure for the concurrent injury of bones, the use of temporary intravascular shunt, treatment of concurrent injuries and prophylactic fasciotomy.

METHODOLOGY:
We collected retrospectively data of 73 patients treated with vascular injuries of the lower limbs at traumatology department of University hospital in Ostrava in the period from 01.01.2001 to 31.12.2010. In this group were 59 men and 14 women, average age 42.4 years (range 786 years), 6 patients suffered vascular injuries to both legs. Most of the injuries were blunt – in 50 patients. Primary amputation was necessary to perform in 27 cases. Persistent signs of ischaemia and extensive soft tissue infections have required subsequent amputation in 13 patients. Resection and replacement of the affected artery (bypass) was done in 16 patients, simple suture of the injured arteries in 8 patients, endovascular treatment in 4 patients.

RESULTS:
Of the 79 injured limb amputation was indicated in 40 cases. In fifteen patients was done the stabilization of long bone fractures or knee dislocation with vascular treatment. For ten of them vascular reconstruction preceded osteosynthesis, five of them fixation preceded vascular reconstruction. It was not reported injuries of vascular reconstruction during subsequent osteosynthesis. We did not use temporary intravascular shunt. In fifteen patient from the whole set was performed fasciotomy for compartment syndrome.

CONCLUSION:
Early restoration of blood flow and patency of vascular reconstruction has the greatest effect of viability of the limb. The resulting functional impairment is mainly due to extent of involvement of surrounding tissues. It was not reported injury of vascular reconstruction during subsequent skeletal fixation, therefore the vascular reconstruction should precede the stabilization of the skeleton.

Key words:
vascular injury, lower limb, MESS.


Sources

1. BECHARA, C., HUYNH, T. T. et al. Management of lower extremity arterial injuries. J Cardiovasc Surg. 2009, 48, 567–579.

2. CLOUSE, W. D., RASMUSSEN, T. E. et al. In-theater management of vascular injury: 2 years of the Balad Vascular Registry. J Am Coll Surg. 2009, 204, 625–632.

3. CONNOLLY, J. F., WHITTAKER, D. et al. Femoral and tibial fractures combined with injuries to the femoral or popliteal artery. A review of the literature and analysis of fourteen cases. J Bone Joint Surg Am. 2007, 53, 56–68.

4. DROST, T. F., ROSEMURGY, A. S. et al. Outcome of treatment of combined orthopedic and arterial trauma to the lower extremity. J Trauma. 1989, 29, 1331–1334.

5. FIRT, P., HEJNAL, R., VANĚK, I. Cévní chirurgie. Praha: Nakladatelství Karolinum, 2006. str. 45-48

6. FOWLER, J., MACINTYRE, N. et al. The impor-tance of surgical sequence in the treatment of lower extremity injuries with concomitant vascular injury: A meta-analysis. Injury. 2009, 40, 72–76.

7. GLASS, G. E., PEARSE, M. F. et al. Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm. J Plast Reconstr Aesthet Surg. 2009, 62, 571–579.

8. GRANCHI, T., SCHMITTLING, Z. et al. Prolonged use of intraluminal arterial shunts without systemic anticoagulation. Am J Surg. 2009. 108, 493–496, discussion 496–497.

9. GUERCIO, N., ORSINI, G. Fractures of the limbs complicated by ischaemia due to lesions of the major vessels. Ital J Orthop Traumatol. 1984, 10, 163–185.

10. HAFEZ, H. M., WOOLGAR, J. et al. Lower extre-mity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001, 33, 1212–1219.

11. HOLLIS, J. D., DALEY, B. J. 10-year review of knee dislocations: is arteriography always necessary? J Trauma. 2005, 59, 672–675; discussion 675–676.

12. JOHANSEN, K., DAINES, M. et al. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990, 30, 568–572; discussion 572–573.

13. KHALIL, I. M., LIVINGSTON, D. H. Intravascular shunts in complex lower limb trauma. J Vasc Surg. 1986, 4, 582–587.

14. KLINEBERG, E. O., CRITES, B., M. et al. The role of arteriography in assessing popliteal artery injury in knee dislocations. J Trauma. 2004, 56, 786–790.

15. KLUGER, Y., M., GONZE, D. et al.. Blunt vascular injury associated with closed mid-shaft femur frac-ture: a plea for concern. J Trauma. 1994, 36, 222–225.

16. KOOTSTRA, G., J. J. SCHIPPER, et al. Femoral shaft fracture with injury of the superficial femoral artery in civilian accidents. Surg Gynecol Obstet. 1976, 142, 399–403.

17. MCHENRY, T. P., HOLCOMB, J. B. Fractures with major vascular injuries from gunshot wounds: impli-cations of surgical sequence. J Trauma. 2002, 53, 717–721.

18. MILLER, H. H., WELCH, C. S. Quantitative studies on the time factor in arterial injuries. Ann Surg. 1949, 130. 428-38!V17(49) R-00977.

19. PECK, M. A., CLOUSE, W. D. et al. The complete management of extremity vascular injury in a local population: a wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq. J Vasc Surg. 2007, 45, 1197–1204; discussion 1204–1205.

20. PRICHAYUDH, S., VERANANVATTNA, A. et al. Management of upper extremity vascular injury: outcome related to the Mangled Extremity Severity Score. World J Surg. 2009, 33, 857–863.

21. RECKLING, F. W., PELTIER, L. F. Acute knee dislocations and their complications. Clin Orthop Relat Res. 2004, 422, 135–141.

22. RETHNAM, U., R., YESUPALAN, S. et al. Impact of associated injuries in the floating knee: a retro-spective study. BMC Musculoskelet Disord. 2009, 10, 7.

23. RIOS, A., VILLA, A. et al. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma. 2003, 55, 489–494.

24. ROSENTAL, J. J., GASPAR, M. R. et al. Vascular injuries associated with fractures of the femur. Arch Surg. 1975, 110, 494–499.

25. STANNARD, J. P., SHEILS, T. M. et al. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arterio-graphy. J Bone Joint Surg Am. 2004, 86-A, 910–915.

26. STARR, A. J., HUNT, J. L. et al. Treatment of femur fracture with associated vascular injury. J Trauma. 1996, 40, 17–21.

27. TREIMAN, G. S., YELLIN, A. E. et al. Examination of the patient with a knee dislocation. The case for selective arteriography. Arch Surg. 1992, 127, 1056–1062; discussion 1062–1063.

28. WEAVER, F. A., ROSENTHAL, R. E. et al. Com-bined skeletal and vascular injuries of the lower extremities. Am Surg. 1984, 50, 189–197.

Labels
Surgery Traumatology Trauma surgery
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account