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

Antonio Krüger,Amelie Braunisch,Dietrich Doll,Carla Florido,Tugba Han Yilmaz,Eric Walther

doi:10.1186/1749-7922-8-51

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.

Highlights

Penetrating arterial injuries to the limbs generally show a good outcome if an experienced trauma team operates on them without undue delay
Patients and methods Chris Hani Baragwanath Academic Hospital with approximately 3000 beds is Teaching Hospital of the University of Witwatersrand, as it is the largest hospital in the southern hemisphere
Arterial injuries distal to the bifurcation of the brachial or the trifurcation of the popliteal artery were not included in the study

Summary

Introduction

Penetrating arterial injuries to the limbs generally show a good outcome if an experienced trauma team operates on them without undue delay. Several articles studying this subject were published from our institution within the last two decades [1,2,3,4,5]. 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. Results were benchmarked with our published results from previous years

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