53262648 Vascular Trauma
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VASCULAR TRAUMA
W. Binafsihi
RSPAD RSPAD Gatot Soebroto
Jakarta
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combined
vascular-skeletal
trauma
0.2% of all trauma
10%-15% blunt limb vascular trauma
Howe, Am Surg 1987;53-205
10%-15% blunt limb vascular trauma
0.3%-3% limb arterial injury of all FXs
10%-70% amputation rate
Attebery, J A C S 1996;183:377
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89MF/10yrs rural 10.000sqmiles
Traffic 33%
Farm/Industrial 16%
Gun, knives etc 51%
Kolvunen D
34% arteriography
13 1oamputations
6 2oamputations
12.4% complication
Surgery 1982; 91(6):723-727
Kolvunen D
Nichols K
Silver D
University of Missouri
Health Sciences Center
U.S.A.
12.4% complication
5.6% mortality
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vascular trauma
time
mechanism
PROGNOSTIC FACTORS FOR LIMB SALVAGE
mechanism
anatomic location
associated injuries
physiologic health
clinical presentation
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SEQUENCE
history
clinical
noninvasive
intraop invasive
postop invasive
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vascular trauma
free radicals
neutrophils
degraded arachidonic acids
MOLECULAR BIOLOGIC MILLEU
degraded arachidonic acids
RENAL
LIVER
CARDIAC
LUNGS
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posterior knee dislocation
30%-60% popliteal arterial injury
20%-50% amputation rate
Frykberg, Surg Clin N A 2002;82:67-89
20%-50% amputation rate
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vascular trauma
NEUROLOGIC deficit
SOFT SIGNS
LIMITED hematoma
HISTORY OF hemorrhage
CONTRALATERAL strong pulses
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vascular trauma
ABSENT pulses
BRUIT/thrill
PULSATILE hematoma
ACTIVE hemorrhage
HARD SIGNS
ACTIVE hemorrhage
DISTAL ischaemia pain
pallor
paralysis
paraesthesia
poikilothermia
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vascular trauma
life threathening associated injuries
extremity reperfusion
skeletal stabilization
MANAGEMENT PRIORITIES
skeletal stabilization
soft tissue: debridement
hemostasis
nerve & tendon
irrigation
wound coverage
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skeletal-vascular trauma
perfusion is sine qua non
minimizes delay to maximize salvage
mostly negligible incidence
RATIONALE PRIORITIES
mostly negligible incidence
(of initial vascular disruption)
LIMB SURVIVAL/FUNCTIONS
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combined vascular-skeletal trauma
19 amputations skeletal 60%
vascular 9%
J Trauma 1983;23:279
35 amputations skeletal 36.5%
vascular 16.6%
J Cardiovasc Surg 1979;20:473
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combined vascular-skeletal trauma
interval to revascularization
skeletal 273 minutes
vascular 137 minutes
J Trauma 2003;54:211
vascular 137 minutes
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combined efforts
exposure for proximal and distal control
vessel debridement
distal thrombectomy
distal heparin flush
REPERFUSION CONSIDERATONS
distal heparin flush
RESTORE FUNCTION intraluminary shunt
vascular repair
FASCIOTOMYcompletion arteriography
full thickness tissue coverage
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Ruptur a.Femoralis Superfisial IRuptur a.Femoralis Superfisial I
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Repair & GraftRepair & Graft
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PascaPasca--repair & graftrepair & graft
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Infeksi pasca iskemiaInfeksi pasca iskemia
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1963
Thomas J. FogartyThomas J. Fogarty
1963
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