Challenges in the management of extremity vascular injuries: A wartime experience from a tertiary centre in Sri Lanka.

Autor: de Silva W; University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka., Ubayasiri RA; University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka., Weerasinghe CW; University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka., Wijeyaratne SM; University Surgical Unit, National Hospital of Sri Lanka, No. 1, Regent Street, Colombo 10, Sri Lanka.
Jazyk: angličtina
Zdroj: World journal of emergency surgery : WJES [World J Emerg Surg] 2011 Aug 10; Vol. 6, pp. 24. Date of Electronic Publication: 2011 Aug 10.
DOI: 10.1186/1749-7922-6-24
Abstrakt: 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.
Databáze: MEDLINE
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