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J Korean Soc Emerg Med > Volume 7(1); 1996 > Article
Journal of The Korean Society of Emergency Medicine 1996;7(1): 82-89.
MANAGEMENT OF MAJOR ARTERIAL INJURIES OF THE EXTREMITIES: A STUDY OF 23 CASES
Hyung Seob Won1, Sang Eun Kim1, Seong Man Bae1, Cheol Wan Park1, Keun Lee1, Sang Hoon Cho2, Sang Il Kim2, Byung Wan Woo3
1Department of Emergency Medicine, Chung Ang Gil Hospital, Incheon, Korea
2Department of Vascular Surgery, Chung Ang Gil Hospital, Incheon, Korea
3Department of General surgery, Chung Ang Gil Hospital, Incheon, Korea
  Published online: March 31, 1996.
ABSTRACT
Extremity vascular trauma is common in most emergency centers, and controversy remains about the optimal management of arterial injuries. Retrospectively we reviewed the records of 23 patients who had upper or lower extremity arterial trauma from July 1994 to December 1995. The purpose of this study was to evaluate our department's management policy to major arterial injuries. The leading cause of major arterial injuries was penetrating trauma. We found that there were clinical findings such as absence of or decreased strength of pulsation(82.6%), cool ischemic extremity(69.6%), large expanding hematoma(43.5%), major bleeding(17.4%) and bruit or thill(8.7%). We gave the priority to management of life-threatening injuries and applied the pressure dressing to wounds as early as possible. There were 18 men(78.3%) and 5 women(21.7%); the mean age was 35(range 20-56 years old) years. There were 12 arterial injuries(52.2%) in the upper extremity and 11 arterial injuries(47.8%) in the lower exteremity. The most commonly injured artery was the brachial artery in the upper(34.8%) and the femoral artery in the lower(30.4%) extremity. The etiology included knife stabbing in 10 patients(43.5%), motor vehicle accidents in 6(26.1%), industrial accidents in 4(17.4%), falls in 2(8.7%) and a farm equipment accident in 1 patient(4.3%). The associated injuries were muscle injuries(78.3%), fracture(56.5%), nerve injuries(52.2%), vein injuries(43.5%), shock(17.4%) and dislocation(13.0%). All patients with arterial injuries were given a preoperative prophylactic antibiotic and TIG(tetanus immunoglobulin). We used Doppler technique as a means of detecting the blood flow. Fourteen patients(60.9%) underwent preoperative arteriography in the radiology department . We performed surgical exploration as soon as major arterial injuries were suspected. The most common methods of treating major arterial injuries were interposition vein graft(69.6%) and end to end anastomosis(21.7%). Systemic or locally infused heparin was used for all vascular repairs. In many of our patients(56.5%), fasciotomy was performed before the vascular repair, as a part of the exploration of the distal arteries. There were 2 amputations(8.7%) but no death. The reasons for secondary amputation were wound infection in one and failure to achieve sufficient arterial flow to the involved extremity with resulting gangrene in the other. As the time factor is vitally important in the management of arterial injuries, we advocate prompt and early surgical treatment within 6 hours of the trauma In conclusion, we believe that the crucial factors in successful management of major arterial injuries of the extremities are early diagnosis, prompt treatment, complete debridement, fasciotomy when indicated, and simultaneous treatment of concomitant injuries.
Key words: Arterial injuries
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