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


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.

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.

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.

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.


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