Vascular Surgery Role in Vascular Trauma: An 11-year Analysis of Peripheral Vascular Trauma Management at a Level 1 Trauma Center

Abstract

and did not undergo revascularization was performed with the Student t test. A generalized linear model adjusted for age, sex, initial wound size, and WIfI classification was performed to evaluate risk of wound healing with and without revascularization.Results: There were 211 patients who presented with 317 wounds; 46% of those patients underwent revascularization. The average wound size was 19.1 6 63.6 cm 2 , but notably of the 103 (32.5%) wounds that healed the average size was only 4.8 6 11.6 cm 2 (P ¼ .01). There was no difference in wound size between those who were revascularized or not (P ¼ .8421). Adjusted for initial wound size, the risk of wound healing was no different whether patients were revascularized (relative risk, 1.114; 95% confidence interval, 0.760-1.634; P ¼ .580). For those whose wounds healed, the average WHT and WFP were 143 6 127 days and 798 6 321 days, respectively. The WHT was no faster in patients who were revascularized (142 days vs 143 days; P ¼ .948), but the WFP was longer in the patients who were revascularized (871 days vs 745 days; P <.001), indicating fewer wound recurrences (Table ). The rate of wound recurrence was 6.1 wounds per 100 person-years in the overall study group. There were 64 minor amputations, 53 major amputations, and 76 deaths during the study period.Conclusions: As expected, initial wound size is associated with ability to heal an ischemic wound. Even with wound care and revascularization performed in a multidisciplinary limb salvage center, wound healing rates are low. A combined treatment strategy of wound care and revascularization does not improve WHT, but reduces ischemic wound recurrences.