Reassessment of the role of routine operative exploration in vascular trauma.
During the 5-year period ending December 1978, 390 patients were explored for suspected vascular injury either in the neck or in one of the extremities with 13% morbidity and a 1% mortality rate. Positive exploration for vascular injury in 139 patients (36%) resulted in 28% morbidity and 2% mortality. Negative exploration in 251 patients (64%) was associated with a 5% morbidity and 0.4% mortality. Per cent positive exploration by type of injury was: iatrogenic injury (100%), foreign body laceration (100%), blunt trauma (79%), stab wound (32%), and gunshot wound (31%). Per cent positive exploration by area was: brachium (68%), popliteal area (63%), femoral area (28%), axilla (27%), and neck (25%). Routine exploration of patients at risk for vascular injury can be accomplished with minimal morbidity and mortality but is associated with a low (36%) diagnostic yield. 'Exclusion' arteriography in hemodynamically stable patients with equivocal signs of vascular injury appears to be indicated to increase diagnostic accuracy.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery; D014656:Vascular Surgical Procedures