Major vascular lesions associated with orthopaedic injuries.
Seventeen patients, aged 11-67 years (mean, 32.6), with major vascular injuries associated with traumatic orthopaedic injuries, were treated operatively in the authors' institution over a 4-year period. The most common mechanism of trauma was a high-energy injury (70.8%), and the rate of open injuries was 88.2%; 64.9% of the injuries were located in the lower extremities. The treatment protocol consisted of aggressive resuscitation; Doppler imaging and, when necessary, angiography; stable bone fixation with subsequent vascular repair; and extended wound debridement. The vascular repair for arterial lacerations consisted of (a) end-to-end anastomosis (47.2%); (b) interpositional homologous vein graft (23.6%); (c) vascular decompression through fracture distraction in one patient (5.9%); (d) xenograft interposition (in one patient; 5.9%); (e) venous repair (in three patients; 17.7%); and (f) embolectomy (in all patients). Three vascular reoperations (17.7%) were necessary because of rupture of the anastomosis. The authors' preferred bone stabilization method was external fixation, which was used in 47.2% of cases. Amputation was performed in three cases (17.7%) as a salvage operation. Although six patients (35.4%) were admitted with delayed shock (mean duration, 73.6 +/- 27.8 min), this led to a lethal outcome due to shock lung in only one patient. Another patient developed massive lung embolism 3 months postoperatively and died. The authors believe that this well-organized approach, based on a specific treatment protocol, for patients with severe orthopaedic trauma and concomitant vascular injury, not only improves outcome but gives good to excellent functional results in the majority of patients.
Karavias
D
D
Department of Surgery, University of Patras, School of Medicine, Greece.
Korovessis
P
P
Filos
K S
KS
Siamplis
D
D
Petrocheilos
J
J
Androulakis
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006115:Greece / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D009985:Orthopedics / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000592:standards*; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology / Q000601:surgery*