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

Abstract

BackgroundPenetrating 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.MethodsAll 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).ResultsThere 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).ConclusionPenetrating 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.

Difficulties in the Management of Civilian Peripheral Vascular Trauma and their Complications at the University Teaching Hospital of Yaoundé, Cameroon

“…All vascular lesions identified in this study are the results of penetrating wounds. This is consistent with literature data where penetrating injuries represent more than 2/3 of injuries in the limbs [1][2][3]. Mommsen et al [6], however, found penetrating wounds in only 31.8% of cases and Jawas et al [7] reported stab lesions in 57% of cases.…”

“…Male predominance due to the predominance of trauma in general in men compared to women is the same as in the literature [1][2][3][4][5][6][7][8]. The young age of our patients is also found in several studies.…”

“…These findings in our series, although in the line with that of many authors, could be explained by the increase in criminality in our country associated to an increase use of firearms (4 cases) and bladed weapons (8 cases). There is a preponderance of the lower limb lesions as reported in the literature [2,6,7,9,10]. We have found only 3 cases associated with bone and nerve lesions.…”

“…The management of these lesions is a big challenge for practitioners because it requires urgent action to preserve vital prognosis and reduce morbidity. In addition, some severe lesions present only with occult symptoms and signs and are often overlooked, manifesting later by signs of vascular insufficiency, pseudo-aneurysm or arteriovenous fistula [1][2][3]. Vascular lesions are readily combined with other injuries or enrol in a context of multiple injuries.…”

“…Peripheral vascular injuries are very common and result most often from penetrating wounds [1][2][3]. The management of these lesions is a big challenge for practitioners because it requires urgent action to preserve vital prognosis and reduce morbidity.…”