Vascular injuries: experience during the Afghanistan War.
This is a prospective study done over an 18-month period in three base evacuation hospitals serving the Afghan refugees in Pakistan. Out of 224 patients, 78 had major and 146 had minor arterial injuries. Late presentation was a common finding. Mine explosions ranked first as a causative agent. This explains the high incidence of lower limb affections and minor vascular injuries. In the major arterial injury group, the superficial femoral artery was the commonest injured (33.4%), followed by the brachial (28.2%). Associated major venous injury occurred in 41% of cases while 25.6% had a compound fracture of the nearby bone. All subclavian and axillary artery injury patients had concomitant brachial plexus injury. Arterial repair was done in 73 patients (93.6%) and ligation in 5. The importance of venous repair was emphasised; venous ligation was done in 6 patients only (19.4%). Repeated extensive debridement was done in 4 patients and useful limbs were left. This is believed to be a good alternative for selected cases with extensive muscle laceration. 3 patients died in the early post-operative period and 3 needed amputation (4%). Other complications were graft sloughing (1.3%) thrombosis (6%) and stenosis (9%). Only 56.9% of patients were followed up for 3-6 months.
Sherif
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D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000783:Aneurysm / Q000453:epidemiology; D001158:Arteries / Q000293:injuries*; D001164:Arteriovenous Fistula / Q000453:epidemiology; D001916:Brachial Artery / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D005268:Femoral Vein / Q000293:injuries; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000293:injuries; D011379:Prognosis; D011446:Prospective Studies; D014857:Warfare; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000453:epidemiology* / Q000601:surgery