Vascular trauma in a rural population.

Most reports on vascular trauma from metropolitan centers indicate that prompt repair of injuries contributes to significant limb salvage. A review of 89 cases of vascular trauma seen during the past 10 years revealed higher amputation and complication rates than are usually experienced at urban centers. The University of Missouri Health Sciences Center serves a predominately rural area of 10,000 square miles. The average delay between injury and arrival at the center was 3.4 hours. Farm and industrial accidents accounted for 16% of the cases, motor vehicle accidents 33%, and penetrating wounds from guns, knives, and glass the remainder. Eighty-two percent of the injuries involved extremities, and 12 of 116 injured vessels were veins. Arteriography was performed in 34% of the patients. Surgery consisted of primary repair or autogenous vein graft in 60% of the vessels and ligation in approximately 35%. Thirteen primary amputations were performed for extensive tissue damage. There were six additional delayed amputations, yielding an overall amputation rate of 16.4%. The mortality rate was 5.6%, with deaths occurring only in patients with multiple severe injuries. The complication rate associated with vascular repair was 12.4%. Most complications and all deaths and amputations occurred in patients suffering trauma from farm, industrial, and motor vehicle accidents. These patients also had longer times in transit. The increased amputation and complication rates appear to be related to the severity of injuries and the time lapse before initiation of definitive therapy.