title: Acute ischemia of the lower limb after injury by gunshot: case report and review of literature.
abstract: BACKGROUND
  Civilian and military vascular trauma has evolved dramatically. It is estimated that 80% of all cases of vascular injuries are due to peripheral vascular trauma, most involving the lower extremities. Arterial below-knee injuries by gunshot still remain a challenge, with an associated rate of amputation of 20-54%.
  
  
  METHODS
  This case reports a 48 year-old male patient who sustained a gunshot below his left knee. At hospital admission, loss of substance and hemorrhage at the medial and lateral faces of the upper third of his left leg were present with signs of distal ischemia. Arteriography revealed infra-popliteal arterial lesions of the three arterial axes. Two reversed great saphenous vein interposition grafts were performed into the anterior and posterior tibial arteries with immediate revascularization of the left leg and foot. Later, soft tissue reconstruction was accomplished by a split-thickness skin graft.
  
  
  RESULTS
  At the fifth month of follow-up, the left leg and foot were viable with good healing, without limitations and with controlled pain. Posterior tibial and dorsalis pedis pulses were palpable.
  
  
  CONCLUSIONS
  This case report shows the importance of an adequate team approach for treatment of a gunshot extremity injury with vascular lesion. The authors want to highlight the scientific background evidence and the value of comparing worldwide civilian trauma center outcomes, mostly reported previously from the military field.
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal. joaofcvasconcelos@gmail.com.|Rua Dr. Eduardo Santos Silva, no. 338, 2º Centro-Frente, 4200-280, Porto, Portugal. joaofcvasconcelos@gmail.com.
authors.forename: J F C
authors.initials: JF
authors.lastname: de Vasconcelos
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: V
authors.initials: V
authors.lastname: Martins
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: D
authors.initials: D
authors.lastname: Brandão
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Maia
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Ferreira
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Braga
authors.affiliation: Plastic, Reconstructive, Maxillofacial and Microsurgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Rios
authors.affiliation: Plastic, Reconstructive, Maxillofacial and Microsurgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: H
authors.initials: H
authors.lastname: Costa
authors.affiliation: Angiology and Vascular Surgery Department, Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal.
authors.forename: A G
authors.initials: AG
authors.lastname: Vaz
keywords: Acute ischemia; Gunshot; Lower limb; Vascular trauma
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