title: Challenges in the management of extremity vascular injuries: A wartime experience from a tertiary centre in Sri Lanka.
abstract: BACKGROUND
  Management of peripheral vascular injuries often present critical challenges in resource limited settings of developing countries. The additional burden from a military conflict poses further challenges. Delays in presentation often result in the loss of limb and even life, in what is usually a young active population. The objective of this report is to analyse the early outcome of vascular intervention at a tertiary referral centre in Sri Lanka.
  
  
  METHODS
  A retrospective descriptive review of eighty one consecutive extremity vascular injuries in seventy patients during a seven month period was performed with regards to the cause of injury, types of presentations, ischaemia time, interventional procedures, complications and early outcome.
  
  
  RESULTS
  Mean age was 31.2 years (9-72 years) and 96% were males. Injuries were caused by blasts in 41%, cuts in 26%, gunshots in 17% and road traffic injuries in 9%. Indications for revascularization were acute ischaemia in 44%, active bleeding in 43% and pseudo-aneurysms in 13%. Six patients underwent primary amputations due to non-viable limbs. 64 patients underwent vascular intervention. Fifty one percent needed vein grafts while 46% had direct repairs. Bleeding was often (73%) from upper extremity injuries. Median time to revascularization was 5.5 (2-16) hours with all limbs salvaged. Acute ischaemia (40%) was often from popliteal injuries. Median time to revascularization was 10 (5-18) hours and viability was prejudged at fasciotomy. 92% of revascularized limbs were salvaged. There was no perioperative mortality.
  
  
  CONCLUSIONS
  Results from vascular repairs are encouraging despite significant delays.
authors.affiliation: University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka.
authors.forename: Wdd
authors.initials: W
authors.lastname: de Silva
authors.affiliation: University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka.
authors.forename: R A
authors.initials: RA
authors.lastname: Ubayasiri
authors.affiliation: University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka.
authors.forename: C W
authors.initials: CW
authors.lastname: Weerasinghe
authors.affiliation: University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka.
authors.forename: S M
authors.initials: SM
authors.lastname: Wijeyaratne