Penetrating arterial trauma to the limbs: outcome of a modified protocol

World Journal of Emergency Surgery

Dietrich Doll¹  Tugba Han Yilmaz³  Eric Walther²  Amelie Braunisch²  Carla Florido²  Antonio Krüger² 

[1] Department of Surgery, St.-Marien-Hospital Vechta, Teaching Hospital of the MHH Hannover University, Vechta, Germany;Department of Trauma-, Hand- and Reconstructive Surgery, Philipps-University, Baldingerstr. 1, Marburg, Germany;Department of Surgery, Izmir, Turkey, Baskent University, Ankara, Turkey

关键词: Vascular surgeon;    Vascular repair;    Amputation rate;    Outcome;    Treatment protocol;    Penetrating trauma;    Popliteal artery;   

Others  :  791576
DOI  :  10.1186/1749-7922-8-51

 received in 2013-10-02, accepted in 2013-11-29,  发布年份 2013

【 摘 要 】

Background

Penetrating arterial injuries to the limbs are common injuries in high volume trauma centers. Their overall surgical results reported in the literature are satisfactory - apart of those of the popliteal artery that still may lead to a significant incidence in amputations. With the present study we assessed our outcome with penetrating arterial injuries to the limb as to see if the direct involvement of vascular surgeons in the management of popliteal artery injuries leads to an improved (lowered) amputation rate. Results were benchmarked with our published results from previous years.

Methods

All patients sustaining penetrating arterial injuries to the limbs admitted to the Chris Hani Baragwanath Academic Hospital during an 18- month period ending in September 2011 were included in this study. Axillary, brachial and femoral artery injuries were operated on by the trauma surgeons as in the past. All popliteal artery injuries were operated on by the vascular surgeons (new).

Results

There were a total of 113 patients with 116 injuries, as some patients had multiple vascular injuries: 10 axillary, 47 brachial, 34 femoral and 25 popliteal artery injuries. Outcome of axillary, brachial and femoral artery injury repair were excellent and not significantly different from our previous reported experience. Injury to the popliteal artery showed a diminished re-exploration rate from 34% down to 10% (p = 0,049) and a decrease of amputation rate from 16% to 11% which was statistically not significant (p = 0,8).

Conclusion

Penetrating arterial trauma to the axillary, brachial and femoral artery is followed by excellent results when operated by trauma surgeons. In the case of popliteal artery injury operated by the vascular surgeons, the results of this study do not show any statistically significant difference related to amputation rate from our previous reported studies when operated by trauma surgeons. Taking into consideration the diminished re-exploration rate and a tendency to a lower amputation rate, we feel that there is possible tendency of better outcome if operated by vascular surgeons. Multicenter studies with large number of enrolled patients will be required to prove the validity of this suggestion.

【 授权许可】

   
2013 Krüger et al.; licensee BioMed Central Ltd.

【 图 表 】

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Figure 2.

【 参考文献 】

• [1]Degiannis E, Bowley DM, Bode F, Lynn WR, Glapa M, Baxter S, Shapey J, Smith MD, Doll D: Ballistic arterial trauma to the lower extremity: recent South African experience. Am Surg 2007, 73:1136-1139.
• [2]Degiannis E, Levy RD, Sofianos C, Florizoone MG, Saadia R: Arterial gunshot injuries of the extremities: a South African experience. J Trauma 1995, 39:570-575.
• [3]Degiannis E, Levy RD, Potokar T, Saadia R: Penetrating injuries of the axillary artery. Aust N Z J Surg 1995, 65:327-330.
• [4]Bowley DM, Degiannis E, Goosen J, Boffard KD: Penetrating vascular trauma in Johannesburg, South Africa. Surg Clin North Am 2002, 82:221-235.
• [5]Degiannis E, Smith MD: (2005) Vascular injuries. In Ballistic Trauma. 2nd edition. Edited by Mahoney PF, Ryan JM, Brooks AJ, Schwab CW. London: Springer; 2005.
• [6]Frykberg ER: Arteriography of the injured extremity: are we in proximity to an answer? J Trauma 1992, 32:551-552.
• [7]Barros D’Sa AA, Harkin DW, Blair PH, Hood JM, McIlrath E: The Belfast approach to managing complex lower limb vascular injuries. Eur J Vasc Endovasc Surg 2006, 32:246-256.
• [8]Shergill G, Bonney G, Munshi P, Birch R: The radial and posterior interosseous nerves. Results fo 260 repairs. J Bone Joint Surg Br 2001, 83:646-649.
• [9]Frykberg ER, Dennis JW, Bishop K, Laneve L, Alexander RH: The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year. J Trauma 1991, 31:502-511.
• [10]Wali MA: Upper limb vascular trauma in the Asir region of Saudi Arabia. Ann Thorac Cardiovasc Surg 2002, 8:298-301.
• [11]Graham JM, Mattox KL, Feliciano DV, DeBakey ME: Vascular injuries of the axilla. Ann Surg 1982, 195:232-238.
• [12]Ergunes K, Yilik L, Ozsoyler I, Kestelli M, Ozbek C, Gurbuz A: Traumatic brachial artery injuries. Tex Heart Inst J 2006, 33:31-34.
• [13]Ekim H, Tuncer M: Management of traumatic brachial artery injuries: a report on 49 patients. Ann Saudi Med 2009, 29:105-109.
• [14]Zellweger R, Hess F, Nicol A, Omoshoro-Jones J, Kahn D, Navsaria P: An analysis of 124 surgically managed brachial artery injuries. Am J Surg 2004, 188:240-245.
• [15]Rasouli MR, Moini M, Khaji A: Civilian traumatic vascular injuries of the upper extremity:report of the Iranian national trauma project. Ann Thorac Cardiovasc Surg 2009, 15:389-393.
• [16]Fox CJ, Perkins JG, Kragh JF Jr, Singh NN, Patel B, Ficke JR: Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb. J Trauma 2010, 69(Suppl 1):S123-S134.
• [17]Cakir O, Subasi M, Erdem K, Eren N: Treatment of vascular injuries associated with limb fractures. Ann R Coll Surg Engl 2005, 87:348-352.
• [18]Feliciano DV, Herskowitz K, O’Gorman RB, Cruse PA, Brandt ML, Burch JM, Mattox KL: Management of vascular injuries in the lower extremities. J Trauma 1988, 28:319-328.
• [19]Asensio JA, Kuncir EJ, Garcia-Nunez LM, Petrone P: Femoral vessel injuries: analysis of factors predictive of outcomes. J Am Coll Surg 2006, 203:512-520.
• [20]Degiannis E, Velmahos GC, Florizoone MG, Levy RD, Ross J, Saadia R: Penetrating injuries of the popliteal artery: the Baragwanath experience. Ann R Coll Surg Engl 1994, 76:307-310.