EXTREMITY VASCULAR TRAUMA EXPERIENCE AT CIVIL SANDAMAN TEACHING HOSPITAL & BOLAN MEDICAL COLLEGE QUETTA

Abstract

To evaluate vascular trauma management mainly on clinical assessment, at less equipped set up and to find out etiological factors, early and late presentation, deferent vascular technique, site of injury, their outcome in early and late arrival and outcome of surgery in vascular injuries. A Prospective study of vascular trauma patients presented to the emergency department of civil sandaman teaching Hospital Quetta, Jellani hospital, Akram hospital, Mansoor hospital Quetta, with acute vascular injuries from august 1995 to July 2003, were assessed. The Mangled Extremity Severity Score (MESS) was calculated for majority of individual to determine the magnitude of injury. A trauma database advised to analyzed each patients characteristics, time since the injury divided into early presentation < 6 hours were compared those presenting late more >6hours, etiology of trauma, surgical procedure, hospital mortality, complication associated injuries and outcome was assessed. One fifty-five patients of vascular injuries were managed. The male to female ratio was 142:13 with an age range of 8 to 65 years. The time since injury ranged 2-22 hours (mean9.3). 74.8% cases sustained vascular trauma by firearm followed by stab injuries 12.2%, blunt trauma 7.7% and 5.1% by crushed injury. 63.8% were arteries, 12.9% were venous, remaining were mixed, upper limb injuries were 25.8% lower limb 60%, the remaining were abdominal or neck injuries. Arterial bleeding from the wound was the most frequent presentation found in 40%, patients followed by absent distal pulses recorded in 32% subjects, complete vascular transaction was the most common operative finding noted in 47.09% cases followed by partial tear in 39.3%. Injuries treated with end to end anastomosis in 14.8%, Vein grafts 58.5%, prosthetic graft in 2.9%, lateral suture 17%, ligation in 6.6% and primary amputation 2.5%, in 84.9% subjects had a functional limb after vascular reconstruction, wound complication was recorded in 12% individuals. 15 (9.6%) patients died within 21 hours of injuries all due to torrential hemorrhage. Conclusion Extremity vascular trauma occur because of direct or indirect trauma and may result in loss of limb or function. Early recognition and prompt surgical intervention, use of saphenous vein graft and fasciotomy contributes to a successful outcome to save life and limbs in vascular trauma patients, the emergency physician is responsible for expedient recognition of injuries and rapid, appropriate consultation while stabilizing the patient.