Ramírez GAH

Language: Spanish
References: 14
Page: 185-189
PDF size: 133.22 Kb.

ABSTRACT

Introduction: Vascular trauma, in our civilian practice, have always been a challenge; most of the vascular surgeons, rarely have the opportunity to get in contact with this kind of injuries, mostly because patients with massive obliteration of the tissue, resulting from high speed projectiles, or vehicles accidents, most of the times do not make it into an ER to get intervened.
Objective: To analyze the causes leading to a vascular trauma of the lower extremity; as well as the influential factors associated with limb loss.
Patients and methods: In the past 23 years of medical practice, we have examined 100 patients suffering from vascular trauma, 39 of them presented lower limb traumatic arterial injuries.
34 of all these patients were males, and only 5 females, with ages ranging from 8 to 77 years; 30.5 years of age on average.
Results: On these events the most frequent injury presented, was produced by a fire arm projectile; the superficial femoral artery received damage most of the times and the most frequent vascular injuries where: transsection 15 patients (38%) and laceration 11 patients (28%).
Death occurred in four events (11%), 3 patients died as a result of secondary to shock condition, another one died as a result of pulmonary thromboembolism.
The overall amputation rate was 23% (9 amputations), 4 of them had a primary mutilation. The remaining five had delayed amputation.
The limb salvage was possible on 74% of the cases within the first 24 hours.
Conclusions: Receiving attention within the first 8 hours from the incident is conclusive, to lead a good result on a vascular event. Lower extremity vascular injuries, produce a large percentage of limbs amputated. Some of the factors that directly affected a decision to amputate are: type of trauma, injured artery, extent of the injuries on soft and skeletal tissue and evolution of the trauma timing.

REFERENCES

1. Castañeda G, Sigler M, Rish F. Generalidades y Epidemiología. En: Trauma Vascular. Cap. 2. Ed. Alfil, 2007, p. 17-20.

2. Mc Cready RA. Upper extremity arterial injuries. Surg Clin North Am 1988; 68(4): 725-40.

3. Ramírez AH, Pérez Y, Neri A, Estrada H, Murillo D. Lesión traumática de la arteria subclavia, vías de acceso. Rev Mex Angiología 2004; 29: 15-19.

4. Ramírez AH, Pérez Y, Ayala A, Estrada H, Camargo F, et al. Lesión vascular traumática de las extremidades superiores. Experiencia en Uruapan Michoacán, México. Rev Mex Angiología 2004; 32: 77-83.

5. Peña F, Castañeda R: Lesiones vasculares de la extremidad inferior. En Trauma vascular. Ed. Alfil capítulo 14, 2007, 135-46

6. Thompson I, Muduioa G, Gray A. Vascular Trauma in New Zealand: an 11 year review of NZVASC THE New Zealand Society of vascular Surgeons’ audit database. N Zealand Medical J 2004; 117: 1201.

7. Ramírez González AH. Trauma Vascular, Experiencia en la práctica privada (1982-1993). Rev Méx Angiología, 1996; 24(1): 6-9.

8. Mullenix P, Steel S, Andersen Ch, Starnes B, Salim A, Martin M, Limb Salvage and outcomes among patients with traumatic popliteal vascular injury: An analysis of the National Trauma Data Bank. J Vasc Surg 2006; 44: 94-100.

9. Padberg F, Rubelowsky J, Hernández-Maldonado J. Milazzo V, Swan K, Lee B, Hobson R, Infrapopliteal arterial injury: Prompt revascularization affords optimal limb salvage. J Vasc Surg 1992; l6: 877-86.

10. Hafez H, Wolgar J, Robbs J. Lower extremity arterial injury: Results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 2001; 33: 1212-9.

11. Peña F, Castañeda R. Lesiones vasculares de la extremidad inferior. En Trauma Vascular. Cap. 14. Ed. Alfil; 2007, p. 135-46.

12. Fox Ch, Gillespie D, O’Donell S, Rasmussen T, Goff G, Jhonson Ch, et al. Contemporary management of wartime vascular trauma. J Vasc Surg 2005; 41: 638-44.

13. Kumar MK, Badole CM, Patond KR. Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs. Indian J Orthop [serial online] 2007; 41: 183-7. Available from: http://www.ijoonline.com/text.asp?2007/41/3/183/33679.

14. Helfet D, Howey T, Sanders R, Johansen K. Estremity Severity Score. Clin Orthop 1990; (256): 80-6.