Vascular repair in trauma - critical analysis for improving limb salvage.

Bala Kumar, P S (2006) Vascular repair in trauma - critical analysis for improving limb salvage. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : With continued urbanization over last few decades there has been an alarming and unabated increase in the incidence of traumatic vascular injuries. Between 1-5% of trauma cases involved injury to a major vascular structure which confronts us with the twin problem of haemorrhage on one hand and ischemia on the other hand. The lives and limbs jeoparadised in these critical vascular injuries often belong to young people and their salvage may mean many years of satisfactory function. Though most advances in treatment of vascular injuries has evolved from war surgery it is quite surprising that it was not until 1950s that effective vascular repair was attempted. In an analysed series of 2471 acute arterial wounds from world war-2 end to end anastomosis was accomplished in only three instances. In fact ligation of a artery was the main stay of treatment then and resulted in an amputation rate of about 40%. Reconstruction of the artery was first employed routinely during the Korean war and the amputation rate dramatically dropped to 13%. Further improvement was achieved in Vietnam war largely as a result of further reduction in time lag and availability of expert vascular surgeon these lessons of war time surgery have been applied in peace time injury and restortation of normal blood flow and not merely saving life is prime objective now. AIM OF THE STUDY : This prospective study of vascular injuries in extremities was conducted in Government General Hospital, Chennai during the period from September 2003 to September 2005. The objectives of the study are:- 1) To study the various etiopathological factors involved and modes of clinical presentation. 2) To assess diagnostic difficulties 3) To analyse the factors influencing ultimate result. 4) To compare and contrast injury pattern and results achieved with world literature. 5) Methods to improve limb salvage. CONCLUSION : 65 Patients with arterial injury of extremities were treated during 24 month period. It is significant that 96.1% were in peak of their youth (3rd decade). A marked male preponderance of 98% was noted. Automobile accidents and penetrating injury were predominant causes. Iatrogenic injury occurred in about 4.6% of the patients. About 90% of acute arterial injury endangered the limbs superficial femoral artery, popliteal artery and brachial artery were seen most frequently. Average ischemic time was 16.75 hours with preadmission delay contributing much. ‘Proximity’ was a important clue in our series as almost all cases had injuries or fracture close to the arteries. But nearly ¼ had palpable distal pulses inspite of arterial injury, indicating that absent pulses alone was inadequate to be the sole indication for exploration. Portable doppler velocity meter gave valuable immediate information at the bed side augment the clinical diagnosis. Arterial repair was accomplished with autogenous vein graft in 73.8% patients and end to end anastomosis in 7.6% patients and venous repair done in 15.1% percentage of patient. Associated orthopaedic and nerve injury were responsible for most of the functional impairment and limb losses. A limb salvage rate of Lower Limb 75% and Upper Limb 95% was achieved. There was seven death due to arterial injuries in this series.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Vascular repair ; trauma ; critical analysis ; improving limb salvage.
Subjects: MEDICAL > Vascular Surgery
Depositing User: Kambaraman B
Date Deposited: 24 Jul 2017 01:31
Last Modified: 24 Jul 2017 01:32

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