title: Management of Vascular Injuries in a Forward Hospital.
abstract: BACKGROUND
  Management of vascular injuries poses a challenging problem under warlike conditions. Several authorities recommend limb revascularisation only within first 6-8 hours, as the outcome after delayed revascularisation is poor.
  
  
  METHODS
  A retrospective analysis of 61 consecutive patients with vascular injury in a forward hospital over a 25- month period was carried out.
  
  
  RESULTS
  Vascular injuries constituted 3.1% of all injuries. The mean injury to treatment delay (lag time) was 11 hours, and 10 patients received treatment after 12 hours. The overall amputation rate was 15%, but only 6.5% for those revascularised within 12 hours and 44% for those undergoing surgery after 12 hours (Chi-square 4.59, p < 0.05). Presence of associated fractures was associated with an adverse outcome (Chi-square 4.24, p < 0.05), as was ligation in comparison to revascularisation (Chi-square 7.86, p < 0.005). Popliteal injuries were associated with a high amputation rate.
  
  
  CONCLUSIONS
  Failure to revascularise (ligation of artery), presence of associated fracture, and restoration of circulation beyond 12 hours are associated with a high amputation rate.
authors.affiliation: Assoc Prof (Surgery), Armed Forces Medical College, Pune-411040.
authors.forename: K M
authors.initials: KM
authors.lastname: Rai
authors.affiliation: CMO, Southern Naval Command.
authors.forename: S K
authors.initials: SK
authors.lastname: Mohanty
authors.affiliation: Senior Adviser (Surgery & Paediatric Surgery), AH (RR), Delhi Cantt.
authors.forename: R
authors.initials: R
authors.lastname: Kale
authors.affiliation: Senior Adviser (Anaesthesiology) 155 BH, C/o 99APO.
authors.forename: A
authors.initials: A
authors.lastname: Chakrabarty
authors.affiliation: Formerly Commandant, 92 BH, C/o 56 APO.
authors.forename: D
authors.initials: D
authors.lastname: Prasad
keywords: Vascular injuries; amputation; trauma