[Arterial vascular injuries in fractures and dislocations].
We analyzed reasons, numbers and results of arterial lesions accompanying fractures (n = 21) and luxations (n = 6) in a 6-year-period (1993-1998) retrospectively. Traffic accidents were in nearly 50% responsible for the injuries. 8 patients had suffered multiple injuries. In 17 patients the lower, and in 10 patients the upper extremities were affected. The vascular wall was completely disrupted or severed in 74%. In 7 cases (26%), patients had suffered blunt or indirect arterial trauma with intima- and media-lacerations due to subcapital fracture of the humerus (n = 2), fractured femoral bone (n = 1), luxation of the knee joint (n = 3) or the elbow (n = 1). The mean preoperative time period was 6 hours and 20 minutes (2 to 16 hours) in patients with complete ischaemia. Vascular reconstruction was performed by interposition of an autologous vein graft or an autologous venous bypass (n = 20), by direct reconstruction and primary suturing (n = 2), by use of a venous patch plasty (n = 2) and, in a single case, by autologous bypass procedure. In one case, a crural artery was ligated, in another case with a Mangled Extremity Severity Score (MESS) of 7 points a primary amputation of the lower leg was necessary. In 5 patients (19%) secondary amputations were performed. No patient died. The final outcome is mostly influenced by the preoperative period of ischaemia.
Piatek
S
S
Klinik für Unfallchirurgie, Otto-von-Guericke-Universität Magdeburg.
Bürger
T
T
Halloul
Z
Z
Westphal
T
T
Holmenschlager
F
F
Winckler
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001132:Arm / Q000098:blood supply*; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013536:Suture Techniques; D014680:Veins / Q000637:transplantation