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Hussein AM, Ali AA, Ahmed SA, Mohamud MFY, Ahmed MAM, Kizilay M. Our experience with blast and gunshot induced traumatic vascular injuries at Somalia's major vascular referral center. Sci Rep 2024; 14:13004. [PMID: 38844514 PMCID: PMC11156839 DOI: 10.1038/s41598-024-63686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
Blast and gunshot-induced penetrating traumatic vascular injuries represent a significant portion of patients with vascular trauma in countries where there are higher rates of war-related violence. These injuries are especially challenging in resource-limited countries due to early diagnosis and transfer delays. This report aimed to present our experience regarding the surgical management and outcome of such injuries at a major referral vascular surgery centre in the country. A retrospective descriptive review of 326 patients with blast and gunshot-induced penetrating traumatic vascular injuries managed during a five-year period between April 2018 and April 2023. The demographics, mechanism of injury, type of vascular injury, Anatomical location, time to the operation, length of hospital stay, amount of blood products given, concomitant neuroskeletal injuries, development of Vascular injury associated acute kidney injury, surgical procedures performed and patient outcome were reviewed. In this study, 326 patients with 445 vascular injuries fulfilled the inclusion criteria. Most of the patients were male 92.3%, and the mean age was 28.3 ± 9.9 years. The gunshot mechanism of vascular injury was implicated in 76.1% of the injuries, and explosive-induced injury was 78 (23.9%). 193 (59.2%) of the patients had isolated arterial injuries, 117 (35.9%) patients had combined arterial and venous injuries while 18 (4.9%) patients had isolated venous injuries. The most commonly injured arteries were the femoral artery, followed by Brachial and popliteal artery injuries (26.1%, 23.5% and 19.4%, respectively). The median time to revascularization was 8.8 ± 8.7 h. 46.8% of the patients had Concomitant fractures, while 26.5% had Concomitant nerve injuries. Only three patients had temporary non-heparin-bound shunts during their arrival. The most common surgical intervention in arterial injuries was reversed saphenous vein graft 46.1%. The mortality was 5.8% and 7.7% of the patients needed secondary amputation. The majority of wartime arterial injuries are a result of Blast and gunshot vascular injuries. Frequent need for autologous vein grafts should be considered to manage such injuries. Results are encouraging despite delays in intervention; therefore, all viable limbs should be revascularized, keeping in mind the long-term functionality of the limb.
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Affiliation(s)
- Abdinafic Mohamud Hussein
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia.
- Department of General Surgery, Benadir University, Mogadishu, Somalia.
| | - Abdijalil Abdullahi Ali
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Said Abdirahman Ahmed
- Department of Cardiology, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Farah Yusuf Mohamud
- Department of Emergency Medicine, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Mohammed A M Ahmed
- Department of Pediatrics, Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia
| | - Mehmet Kizilay
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
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Giordano V, Souza FS, Belangero WD, Pires RE. Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection-The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1220. [PMID: 34833438 PMCID: PMC8624929 DOI: 10.3390/medicina57111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Open traumatic lesion of the popliteal artery is relatively rare. Ischemia time longer than 6 h and severity of limb ischemia have been shown to be associated with an increased risk of limb loss. Severe local infection is critical in the presence of major soft tissue trauma or open fractures. We report the case of a young female who suffered a traumatic transection of the popliteal artery associated with an open fracture of the distal tibia and fibula managed by direct vessel reconstruction with an end-to-end repair and skeletal stabilization initially with half-pin external fixation, then replaced by an Ilizarov circular frame. The patient had a very satisfactory outcome, but the fracture healed malunited, later corrected by open reduction and internal fixation with lag-screwing and a neutralization plate.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-060, Brazil;
| | - Felipe Serrão Souza
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro 22430-060, Brazil;
| | - William Dias Belangero
- Departamento de Ortopedia, Universidade Estadual de Campinas, Campinas 13083-887, Brazil;
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil;
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Sandhu J, La Punzina C, Kothuru R. Triple vessel injury with single penetrating trauma to the lower extremity requiring popliteal to posterior tibial artery bypass. Trauma Case Rep 2018; 15:32-35. [PMID: 29876500 PMCID: PMC5987261 DOI: 10.1016/j.tcr.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/22/2022] Open
Abstract
This is a case report describing the delayed presentation of injury to all three lower extremity infrapopliteal arteries after a 34 year old male sustained multiple gunshot wounds, including one to his left lower extremity. As part of his initial assessment, ankle brachial index was performed and was found to be abnormal. Further work up for this was delayed due to need for emergent trauma laparotomy. After this procedure, more detailed evaluation with CT angiography of the extremity injury was performed. Though imaging indicated adequate perfusion of the lower extremity, serial neurovascular examination revealed inadequate perfusion. The patient required arterial reconstruction and fasciotomies. This case demonstrates the need for continued surveillance of extremity perfusion in atypical trauma cases when index of suspicion suggests the degree of injury may be worse than initial work up may indicate.
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Affiliation(s)
| | - Charles La Punzina
- Department of Surgery, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, United States
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Rasulic L, Cinara I, Samardzic M, Savic A, Zivkovic B, Vitosevic F, Micovic M, Bascarevic V, Puzovic V, Mandic-Rajcevic S. Nerve injuries of the upper extremity associated with vascular trauma-surgical treatment and outcome. Neurosurg Rev 2016; 40:241-249. [PMID: 27241068 DOI: 10.1007/s10143-016-0755-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/04/2016] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Abstract
Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is a high chance of combined injuries of these structures (23 %). The aim of our study is to describe and analyze associated nerve and vascular injuries of the upper extremity in patients treated at the Clinic of Neurosurgery in Belgrade over a 10-year period. This study included 83 patients that received surgical treatment at the Clinic of Neurosurgery in Belgrade after having been diagnosed with upper extremity nerve injury. The study included all patients that satisfied these criteria over a period of 10 years. The patients with associated vascular injuries, 36 of them, were considered our study group, while 47 patients without associated vascular injuries were considered our control group. Finally, we compared treatment outcome between these groups. The final outcome evaluation was performed 2 years after surgical treatment. In our study group, 84.8 % surgical nerve repair was successful (fair, good, and excellent outcome), while in the control group (patients without vascular injury), surgical nerve repair was successful in 87.9 %. The overall satisfactory neurological outcome (M3-M5) was present in 86.6 % of nerve repairs. Our study shows that there is no significant difference between the treatment outcome in patients with associated nerve and vascular injuries and patients with isolated nerve injuries if they are diagnosed in time and treated appropriately. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team.
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Affiliation(s)
- Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Dr Koste Todorovica 4, Belgrade, Serbia. .,Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia.
| | - Ilijas Cinara
- Clinic for vascular and endovascular surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Miroslav Samardzic
- Faculty of Medicine, University of Belgrade, Dr Koste Todorovica 4, Belgrade, Serbia.,Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia
| | - Andrija Savic
- Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia
| | - Bojana Zivkovic
- Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia
| | - Filip Vitosevic
- Center for Radiology and MRI, Clinic of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirko Micovic
- Faculty of Medicine, University of Belgrade, Dr Koste Todorovica 4, Belgrade, Serbia.,Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia
| | - Vladimir Bascarevic
- Faculty of Medicine, University of Belgrade, Dr Koste Todorovica 4, Belgrade, Serbia.,Clinic of Neurosurgery, Clinical Center of Serbia, Dr Koste Todorovica 4, Belgrade, Serbia
| | - Vladimir Puzovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Stefan Mandic-Rajcevic
- Innovation Centre of the Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia
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