Soto GM

Language: Spanish
References: 13
Page: 109-133
PDF size: 118.07 Kb.

ABSTRACT

Objective: To present a series of cases of peripheral arterial injuries cared for at a second level health care military hospital and to demonstrate that these can be handled by a general surgeon.
Setting: Regional Military Hospital of Acapulco, Gro, Mexico.
Design: Retrospective, descriptive, and transversal study.
Statistical analysis: Percentages as summary measure for qualitative variables.
Patients and methods: We reviewed the clinical files of the patients cared for due to peripheral arterial injuries in a 3-year period. Analyzed parameters were: age, gender, injured artery, type of injury, time of evolution, use of antibiotics, type of hemorrhage at admittance, injuring agent, type of vascular repair, associated injuries, and complications.
Results: Seven repairs were performed of peripheral arterial injuries, all in male patients, average age of 31.5 years. Injured arteries were: left common carotid (1), left axillary (1), right humeral (1), left external iliac (1), right common femoral (1), popliteal (2). In six patients, repair was started within the first 3 hours after the injury and in one after 12 hours. A first generation cephalosporin was used perioperatively in all cases. All injuries corresponded to partial transversal sections. Fourty-three percent of patients was admitted with class II hemorrhage and 57% with class III. In five cases, the injury was caused by low-speed gunshot, in one by bull horn, and in one by a blade weapon. The following repairs were made: two saphena grafts, two termino-terminal anastomoses, and three raphies. There were four associated injuries, two venous (one of the internal jugular vein and the other of the external iliac vein) and two visceral (left ureter and sigmoid colon). The patient, whose arterial repair (popliteal) was performed after 12 hours of the injury, developed necrosis of the anterior tibial muscle and of the extensors of the fingers, despite having made fasciotomies
Conclusion: Peripheral arterial injuries are life threatening and/or risk the viability of an extremity and therefore require emergency care. The general surgeon must be trained to resolve efficiently this type of lesions at any level of health care.

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