Retrospective study of 124 patients with major pheripheral vascular injuries which have reached 6 hours after the trauma.

Dr. Mayur B. Agrawal; Dr. Darshan U. Rajput

Volume : VI, Issue : VIII, August - 2017

Retrospective study of 124 patients with major pheripheral vascular injuries which have reached 6 hours after the trauma.

Dr. Mayur B. Agrawal, Dr. Darshan U. Rajput

Abstract :

This is retrospective study of 124 patients from with major peripheral vascular injuries Jan 2012 to August 2106, majority of patients came to our centre with significant delay, as our centre is a referral centre for villages and small towns of north Karnataka, south Maharashtra and Goa , approximately the radius of 200kms and that is the reason for average delay for more than 8 to 12 hours.

In Casualty Once the other life threatening injuries were ruled out, vascular injuries were diagnosed by clinical examination and with help of hand held Doppler, CT Angiogram was not done as there was already significant delay and immediately patient was taken to OT with minimal wheel in time, Fasciotomy of all the compartments were done and good wash was given to drain the toxic fluid to prevent reperfusion injury, than muscle were inspected to look for colour and stimulated to know the viability of muscles. If the muscles were viable then proceeded for definitive vascular reconstruction with interposition reverse saphenous vein graft in patients without unstable fracture, in patients with unstable fractures temporary shunt was used to perfuse the limb and after fracture stabilization , definitive interposition saphenous vein graft was used for vascular reconstruction .

Results:

37.90 % of patients ( 47 patients) were having upper extremity vascular injuries and 62.09 % of patients( 77 patients) were having lower extremity vascular injuries

64 % ( 79 patients ) of patients were having stable fractures ,out of which 8.8 % ( 11 patients ) were treated by doing end to end repair and 54 % were treated using interposition vein graft preceded orthopaedic fixation .

In 36% of patients (45 patients) with unstable fracture revascularisation was done with temporary shunt , definitive vascular repair was done after fracture fixation.

Limb salvage rate in this study is 82.25 %.

Conclusion:

Plastic surgeons should treat the pheripheral vascular injuries primarily as they can assess the soft tissue injuries better than other surgeons ,plastic surgeon should not be a last resort .There is no need of wasting time in doing CT angiography.For combined vascular and bony injuries first priority should be given to revascularisation when patients reaches after 6 hours of injury.