The Outcomes of Salvage Surgery for Vascular Injury in The Extremities: A Special Consideration For Delayed Revascularization
Journal Title: Malaysian Orthopaedic Journal - Year 2014, Vol 8, Issue 1
Abstract
A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients’ limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%), limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann’s ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
Authors and Affiliations
Jagdish Krishnan, M Paiman, AS Nawfar, MI Yusof, W Zulmi, WS Azman, AZ Mat Saad, MD Shafei, WI Faisham
Keywords
Related Articles
- EP ID EP306653
- DOI 10.5704/MOJ.1403.012
- Views 93
- Downloads 0
Internal Fixation of Unstable Pelvic Ring Injuries via the Modified Stoppa Approach
Background: The modified Stoppa approach was first described in 1993 by Hirvensalo as an alternative to the ilioinguinal approach for treatment of pelvic ring fracture. Methods: This is a retrospective study of 5 patien...
Both-Bone Forearm Fractures in Children with Minimum Four Years of Growth Remaining: Can Cast Achieve a Good Outcome at Skeletal Maturity?
Introduction: Both-bone forearm fractures in children can be treated non-operatively with a cast. Most previous studies have shown favourable outcome; however, information on the functional outcome after skeletal maturit...
Coracoid Process Morphology using 3D-CT Imaging in a Malaysian Population
Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid proce...
Functional Outcome of Isolated Hoffa Fractures Treated with Cannulated Cancellous Screw
Introduction: Isolated Hoffa fracture is an infrequent injury and little research has been done on this subject. The purpose of this study was to evaluate the functional outcome and complications of surgically managed Ho...
Acromioclavicular Reconstruction using Autogenous Semitendinosus Tendon Graft and the Importance of Postoperative Rehabilitation: A Case Report
We present a case of chronic acromioclavicular joint dislocation (Rockwood type 5) in which the choice of acromioclavicular reconstruction using autogenous semitendinosus tendon graft was made due to its superiority in a...