| Popis: |
Limb salvage in patients with combined orthopaedic and vascular injuries is highly dependent on the severity of injury and the expeditious diagnosis and treatment of vascular trauma. Diagnostic arteriography should be used selectively to identify an occult injury in patients with an abnormal physical examination or to establish the anatomy and precise location of injury. Measurement of limb pressures using a Doppler device and use of duplex ultrasonography are valuable adjuncts in the rapid evaluation of patients with trauma for arterial injury. When unequivocal evidence of arterial injury is present and the operative approach is established easily by the mechanism and site of injury, treatment should not be delayed by confirmatory arteriography. Vascular repair should precede orthopaedic stabilization particularly if critical ischemia is present. Amputation rates after extremity trauma continue to decrease because of rapid patient transport (decrease in warm ischemia time) and a team approach to injury repair. Technical success of restoring arterial patency and limb perfusion is achieved in95% of patients. Early amputation is related to prolonged ischemia and soft tissue injury that precludes a viable, functional extremity. Late amputation is done for disability, a useless, painful limb, or chronic infection. |
