Moye-Elizalde G, Vera-Díaz Ó

Language: Spanish
References: 7
Page: 162-169
PDF size: 83.81 Kb.

ABSTRACT

The increase in the medical attention of patients injured by gun shot wounds in many hospitals of the country, leads to an increase in vascular injuries, one of the main causes of death and loss of an extremity in this type of injuries. The lack of knowledge of physicians in treating and assessing gun shot wounds, increases the possibility of them not making a diagnosis early in the vascular injurie. It is necessary to take into account the following:

1. Hard data or main data and secondary or soft data in the vascular injury.
2. The prognosis is related with the diagnosis and early repair of vascular injury, that’s why, it’s essential to have a high suspicion in the clinical exam, associated to a well documented medical examination.
3. Approximately 80% of arterial injuries occur in the extremities.
4. The main vessels compromised in these injuries are the superficial femoral artery, humeral artery, popliteal artery (fractures of the middle third and proximal femur and humerus, and proximal third of the tibia).
5. The possibility of vascular injury increases with the fragmentation of the projectile.
6. In stable patients, with soft data of vascular injury, a pre-surgical angiogram is recommended, with this in proactive the negative surgical exploration falls from 84% to 2%.
7. Those patients with main or hard signs of vascular injury should be submitted to an urgent surgical exploration, as the unstable hemodynamic patients, with secondary signs.
8. Almost all patients with a gunshot wound in the extremities, should be assessed by Angiology.

REFERENCES

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6. Burg A, Nachum G, Haviv B, Heller S, Velkes S, Dudkiewicz I. Treating civilian gunshot wounds to the extremities in a level 1 trauma center: Our experience and recommendations. IMAJ 2009; 11: 546-550.

7. Klocker J, Falkensammer J, Pellegrini L, Biebl M, Tauscher T, Fraedrich G. Repair of arterial injury after blumt trauma in the upper extremity: Immediate and long-term outcome. Eur J Vasc Endovasc Surg 2010; 39: 160-164.