Abstract
OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.
Highlights
Vascular injury is a major complication of military and civilian trauma
Blunt injuries account for 6-10% of upper extremity vascular trauma and are often associated with musculoskeletal injuries and neural injuries.[3]
In this report we present the different mechanisms of trauma, arteries involved, associated orthopedic or nerve injuries and types of vascular repairs employed
Summary
Vascular injury is a major complication of military and civilian trauma. Major developments in this field have been related to military conflicts during the past 100 years.[1]Trauma has become a public health problem in many parts of the world, and vascular trauma is an important component of this problem.[2]. Vascular injury is a major complication of military and civilian trauma. Major developments in this field have been related to military conflicts during the past 100 years.[1]. Vascular injuries of the upper extremity – Shalabi R et al. The majority of upper extremity vascular injuries are due to penetrating trauma, with progressively increasing numbers attributable to iatrogenic causes. Blunt injuries account for 6-10% of upper extremity vascular trauma and are often associated with musculoskeletal injuries and neural injuries.[3]. The mechanism of injury seems to differ between different parts of the world.[4,5] While successful treatment of major arterial injuries may be life-saving as well as allowing limb salvage and restoration of function,[6] return of function is often related to the presence of concomitant injury to peripheral nerves.[3]
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