K M Rai1, S K Mohanty2, R Kale3, A Chakrabarty4, D Prasad5. 1. Assoc Prof (Surgery), Armed Forces Medical College, Pune-411040. 2. CMO, Southern Naval Command. 3. Senior Adviser (Surgery & Paediatric Surgery), AH (RR), Delhi Cantt. 4. Senior Adviser (Anaesthesiology) 155 BH, C/o 99APO. 5. Formerly Commandant, 92 BH, C/o 56 APO.
Abstract
BACKGROUND: Management of vascular injuries poses a challenging problem under warlike conditions. Several authorities recommend limb revascularisation only within first 6-8 hours, as the outcome after delayed revascularisation is poor. METHODS: A retrospective analysis of 61 consecutive patients with vascular injury in a forward hospital over a 25- month period was carried out. RESULTS: Vascular injuries constituted 3.1% of all injuries. The mean injury to treatment delay (lag time) was 11 hours, and 10 patients received treatment after 12 hours. The overall amputation rate was 15%, but only 6.5% for those revascularised within 12 hours and 44% for those undergoing surgery after 12 hours (Chi-square 4.59, p < 0.05). Presence of associated fractures was associated with an adverse outcome (Chi-square 4.24, p < 0.05), as was ligation in comparison to revascularisation (Chi-square 7.86, p < 0.005). Popliteal injuries were associated with a high amputation rate. CONCLUSIONS: Failure to revascularise (ligation of artery), presence of associated fracture, and restoration of circulation beyond 12 hours are associated with a high amputation rate.
BACKGROUND: Management of vascular injuries poses a challenging problem under warlike conditions. Several authorities recommend limb revascularisation only within first 6-8 hours, as the outcome after delayed revascularisation is poor. METHODS: A retrospective analysis of 61 consecutive patients with vascular injury in a forward hospital over a 25- month period was carried out. RESULTS:Vascular injuries constituted 3.1% of all injuries. The mean injury to treatment delay (lag time) was 11 hours, and 10 patients received treatment after 12 hours. The overall amputation rate was 15%, but only 6.5% for those revascularised within 12 hours and 44% for those undergoing surgery after 12 hours (Chi-square 4.59, p < 0.05). Presence of associated fractures was associated with an adverse outcome (Chi-square 4.24, p < 0.05), as was ligation in comparison to revascularisation (Chi-square 7.86, p < 0.005). Popliteal injuries were associated with a high amputation rate. CONCLUSIONS: Failure to revascularise (ligation of artery), presence of associated fracture, and restoration of circulation beyond 12 hours are associated with a high amputation rate.
Authors: Lazar B Davidovic; Ilijas S Cinara; Tanja Ille; Dusan M Kostic; Marko V Dragas; Dragan M Markovic Journal: Vascular Date: 2005 May-Jun Impact factor: 1.285
Authors: R Prêtre; I Bruschweiler; J Rossier; M Chilcott; M Bednarkiewicz; K Kürsteiner; A Kalangos; P Hoffmeyer; B Faidutti Journal: J Trauma Date: 1996-04