Strategies in Trauma and Limb Reconstruction

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VOLUME 18 , ISSUE 2 ( May-August, 2023 ) > List of Articles

ORIGINAL RESEARCH

Blunt Vascular Trauma in the Lower Extremity at a Major Trauma Centre: Salvage Rate and Complications

Liam Barnard, Sina Karimian, Patrick Foster, Venugopal K Shankar

Keywords : Amputation, Blunt trauma, Lower limb, Limb salvage, Vascular injury

Citation Information : Barnard L, Karimian S, Foster P, Shankar VK. Blunt Vascular Trauma in the Lower Extremity at a Major Trauma Centre: Salvage Rate and Complications. 2023; 18 (2):87-93.

DOI: 10.5005/jp-journals-10080-1588

License: CC BY-NC-SA 4.0

Published Online: 26-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Blunt trauma of the lower limb with vascular injury can cause devastating outcomes, including loss of limb and even loss of life. The primary aim of this study was to determine the limb salvage rate of patients sustaining such injuries when treated at Leeds General Infirmary (LGI) since becoming a Major Trauma Centre (MTC). The secondary aim was to establish patient complications. Methods: A retrospective analysis found that from 2013 to 2018, 30 patients, comprising of 32 injured limbs, were treated for blunt trauma to the lower limb associated with vascular injury. Results: Twenty-four patients were male and six were female. Their mean ages were 32 and 49, respectively. Three limbs were deemed unsalvageable and underwent primary amputation; of the remaining 29 potentially salvageable limbs, 27 (93%) were saved. Median ischaemic times for both amputees and salvaged limbs were under 6 hours. Of the 32 limbs, 27 (84%) were salvaged. All amputees had a MESS score ≥ 7, although not all patients with MESS ≥ 7 required amputation. Eleven limbs had prophylactic fasciotomies, three limbs developed compartment syndrome – all successfully treated and three contracted deep infections – one of which necessitated amputation. All but one patient survived their injuries and were discharged from the hospital. Conclusion: Attempted salvage of 27/29 (93%) limbs was successful and all but one patient survived these injuries when treated at an MTC. MESS scoring and ischaemic time are useful but not sole predictors of limb salvage. Complication rates are low but may be significant for their future implications.


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  1. Franz RW, Skytta CK, Shah KJ, et al. A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg 2012;26(5):655–664. Available from: DOI: 10.1016/j.jvs.2011.01.052.
  2. Huynh TTT, Pham M, Griffin LW, et al. Management of distal femoral and popliteal arterial injuries: An update. Am J Surg. 2006;192(6):773–778. DOI: 10.1016/j.amjsurg.2006.08.043.
  3. Sriussadaporn S, Pak-art R. Temporary intravascular shunt in complex extremity vascular injuries. J Trauma 2002;52(6):1129–1133. DOI: 10.1097/00005373-200206000-00018.
  4. Hossny A. Blunt popliteal artery injury with complete lower limb ischemia: Is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg 2004;40(1):61–66. DOI: 10.1016/j.jvs.2004.03.003.
  5. Lange R. Open tibial fractures with associated vascular injuries: Prognosis for limb salvage. Trauma 1985;25(2):203–208. DOI: 10.1097/00005373-198503000-00006.
  6. Halvorson JJ, Anz A, Langfitt M, et al. Vascular injury associated with extremity trauma: Initial diagnosis and management. J Am Acad Orthop Surg 2011;19(8):495–504. DOI: 10.5435/00124635-201108000-00005.
  7. Held M, Laubscher M, von Bormann R, et al. High rate of popliteal artery injuries and limb loss in 96 knee dislocations. South African Orthop J 2016;15(1):72–76. DOI: 10.17159/2309-8309/2016/v15n1a8.
  8. Dennis JW, Veldenz HC, Menawat SS, et al. Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating proximity trauma: Five to ten year follow-up. J Trauma Acute Care Surg 1997;43(1). Available from: https://journals.lww.com/jtrauma/Fulltext/1997/07000/Validation_of_Nonoperative_Management_of_Occult.73.aspx.
  9. Jordaan P, Roche S, Maqungo S. Computerised Tomographic Angiography (CTA) in extremity trauma-A level one hospital experience. South African J Surg 2016;54(4):11–16. PMID: 28272850.
  10. Messner J, Harwood P, Johnson L, et al. Lower limb paediatric trauma with bone and soft tissue loss: Ortho-plastic management and outcome in a major trauma centre. Injury 2020;51(7):1576–1583. DOI: 10.1016/j.injury.2020.03.059.
  11. Galvagno SM, Nahmias JT, Young DA. Advanced Trauma Life Support® Update 2019: Management and applications for adults and special populations. Anesthesiol Clin 2019;37(1):13–32. DOI: 10.1016/j.anclin.2018.09.009.
  12. British Orthopaedic Association. Diagnosis and management of arterial injuries associated with extremity fractures and dislocations. 2020;1. Available from: https://www.boa.ac.uk/resources/boast-6-pdf.html%0Ahttps://www.boa.ac.uk/uploads/assets/a50f058e-b5f7-46e9-803d2ac06ecc069b/BOASTArterialInjuries-v21-2021-FINAL.pdf.
  13. TARN. The Injury Severity Score (ISS). Available from: https://www.tarn.ac.uk/Content.aspx?c=3117.
  14. Johansen K, Daines M, Howey T, et al. Objective criteria accurately predict amputation following lower extremity trauma. Trauma 1990;30(5):568–572. DOI: 10.1097/00005373-199005000-00007.
  15. Glass GE, Pearse MF, Nanchahal J. Improving lower limb salvage following fractures with vascular injury: A systematic review and new management algorithm. J Plast Reconstr Aesthetic Surg 2009;62(5):571–579. DOI: 10.1016/j.bjps.2008.11.117.
  16. Rozycki GS, Tremblay LN, Feliciano DV, et al. Blunt vascular trauma in the extremity: Diagnosis, management, and outcome. J Trauma 2003;55(5):814–824. DOI: 10.1097/01.TA.0000087807.44105.AE.
  17. Lohmann M, Lauridsen K, Vedel P. Arterial lesions in major knee trauma: Pedal pulse a false sign of security? Arch Orthop Trauma Surg 1990;109(4):238–239. DOI: 10.1007/BF00453151.
  18. Barnes CJ, Pietrobon R, Higgins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. J Trauma – Inj Infect Crit Care 2002;53(6):1109–1114. DOI: 10.1097/00005373-200212000-00013.
  19. Wagner WH, Yellin AE, Weaver FA, et al. Acute treatment of penetrating popliteal artery trauma: The importance of soft tissue injury. Ann Vasc Surg 1994;8(6):557–565. DOI: 10.1007/BF02017412.
  20. Lin CH, Wei FC, Levin LS, et al. The functional outcome of lower-extremity fractures with vascular injury. J Trauma Acute Care Surg 1997;43(3):480–485. DOI: 10.1097/00005373-199709000-00015.
  21. Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: Results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 2001;33(6):1212–1219. DOI: 10.1067/mva.2001.113982.
  22. Messner J, Johnson L, Taylor DM, et al. Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method. Bone Joint J 2018;100B(3):396–403. DOI: 10.1302/0301-620X.100B3.BJJ-2017-0863.R1.
  23. Foster PAL, Barton SB, Jones SCE, et al. The treatment of complex tibial shaft fractures by the Ilizarov method. J Bone Joint Surg Br 2012;94(12):1678–1683. DOI: 10.1302/0301-620X.94B12.29266.
  24. Johnson L, Messner J, Igoe EJ, et al. Quality of life and post-traumatic stress symptoms in paediatric patients with tibial fractures during treatment with cast or Ilizarov frame. Injury 2020;51(2):199–206. DOI: 10.1016/j.injury.2019.10.077.
  25. Cakir O, Subasi M, Erdem K, et al. Treatment of vascular injuries associated with limb fractures. Ann R Coll Surg Engl 2005;87(5):348–352. DOI: 10.1308/003588405X51146.
  26. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;(250):81–104. PMID: 2403498.
  27. Russell Martin R, Mattox KL, Burch JM, et al. Advances in treatment of vascular injuries from blunt and penetrating limb trauma. World J Surg 1992;16(5):930–937. DOI: 10.1007/BF02066994.
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