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Engelhardt M, Schmid R, Kölbel B, Hyhlik-Dürr A, Zerwes S, Zischek C. Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course. Eur Surg 2023; 55:89-93. [PMID: 37206194 PMCID: PMC10123566 DOI: 10.1007/s10353-023-00800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Background The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce a vascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. Methods The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. Results In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. A fundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with a surgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. Conclusion The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.
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Affiliation(s)
- M. Engelhardt
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - R. Schmid
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - B. Kölbel
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - A. Hyhlik-Dürr
- Medical Faculty, University of Augsburg, Augsburg, Germany
| | - S. Zerwes
- Medical Faculty, University of Augsburg, Augsburg, Germany
| | - C. Zischek
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
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Agarwal P, Kukrele R, Sharma D. Delayed revascularization of extremities following vascular injuries: Challenges and outcome. J Orthop 2023; 35:31-36. [PMID: 36387761 PMCID: PMC9660842 DOI: 10.1016/j.jor.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose In developing countries delayed presentation following major vascular injury is common due to limited vascular trauma units; delay in diagnosis and time lost in transit which pose a major challenge for limb salvage. Aim of this study was to assess limb survival and complications after delayed revascularization of extremity following major vascular injury. Method 20 patients, (19 males and 1 female, mean age 31.55 years) with major extremity vascular injury who presented >8 h after vascular trauma were included in this study. All patients had road traffic accidents as the cause of extremity injury. These patients were operated by primary vascular repairs, thrombectomy and/or interposition vein graft along with fixation of concomitant skeletal trauma. Results The commonest vessel injured was popliteal artery. The mean time of limb revascularization was 30.8 h. Limb salvage rate was 95% and there was no perioperative mortality. 9 patients developed postoperative complications including sloughing of leg muscles (4), foot drop (3) pseudo aneurysm (1) and reperfusion injury (1). At 6 months follow-up all the patients were able to walk with full weight bearing and there was no chronic ischemia, pain or sinuses. Conclusion Limb salvage can be achieved with good results in patients with delayed revascularization in selected cases. However; delayed revascularization leads to long and protracted postoperative course with high chances of vascular and neurological complications.
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Affiliation(s)
- Pawan Agarwal
- Plastic Surgery Unit, Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Rajeev Kukrele
- Plastic Surgery Unit, Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
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Loewenstein S, Rogers C, Kukushliev V, Adkinson J. Risk for Persistent Peripheral Neuropathy After Repair of Brachial Artery Injuries. Cureus 2022; 14:e22997. [PMID: 35415029 PMCID: PMC8992875 DOI: 10.7759/cureus.22997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Brachial artery lacerations are limb-threatening injuries requiring emergent repair. Concomitant peripheral nerve symptoms are often only identified postoperatively. This study evaluated the prevalence of peripheral nerve deficits among this population as the indications for early nerve exploration have not been definitively established. Methods We reviewed all patients sustaining a brachial artery injury at one pediatric and two adult Level I Trauma Centers between January 1, 2007, and December 31, 2017. We recorded patient demographics, comorbidities, intoxication status, injury mechanism, concomitant injuries, type of repair, and intraoperative peripheral nerve exploration findings. Pre-and post-operative and long-term peripheral nerve function examination findings were analyzed. Differences between categorical variables were determined with Chi-square and Fisher’s exact tests. Results Thirty-four patients sustained traumatic brachial artery lacerations requiring operative repair. Injury mechanisms included tidy (clean cut) laceration (n=11, 32%), gunshot wound (n=9, 26%), blunt trauma (n=8, 24%), and untidy laceration (n=6, 18%). Preoperatively, 15% had a normal peripheral nerve examination, 26% had localizable symptoms, 38% had non-localizable symptoms, and 21% were taken to the operating room without formal nerve assessment. Thirty-two percent underwent formal nerve exploration, and 81% underwent nerve repair. At an average follow-up of 2.5 years, 27% of patients underwent exploration, and 39% did not have localizable peripheral nerve deficits (p=0.705). Conclusions Brachial artery injuries are associated with a clinically significant risk for long-term peripheral nerve symptoms. Early nerve exploration in patients with peripheral nerve symptoms after a brachial artery injury may be warranted, although there is no statistically significant likelihood for improved peripheral neurological outcomes.
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Lin CH, Consuegra MDL, Lin TS. Revisiting Management Strategies for Popliteal Artery Injuries. Ann Plast Surg 2022; 88:S44-S49. [PMID: 35102016 DOI: 10.1097/sap.0000000000003067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Popliteal artery injuries (PAIs) were reported to own the highest rates of limb loss in vascular injuries of extremities. The complex nature of PAIs makes the treatment more difficult. We aimed to present our cases using our proposed algorithm and revisit the strategies for management. PATIENTS AND METHODS A retrospective study of 45 cases with PAIs managed at the Kaohsiung Chang Gung Memorial Hospital over a 10-year period was conducted. The proposed algorithm for decision making was applied, which contains variables including the interval before surgery, the revascularization being delayed or not, the presence of fasciotomy, the acquisition of preoperative angiography, and the existence of collateral circulation. Whether the injured limbs were salvaged successfully avoiding amputation was recorded. RESULTS Of all the included 45 patients, the rate of a successful salvage of the injured limb from amputation was 71.1%. Six patients did not receive revascularization because of their poor conditions of the injured limbs. In terms of limb salvage in PAIs, the interval before surgery, the revascularization being delayed or not, the presence of fasciotomy, or the acquisition of preoperative angiography did not make a significant difference (P > 0.05). Instead, an existence of collateral circulation at the distal injured limb was correlated to a significant higher rate of salvage, regardless of having revascularization or not (P = 0.001 and < 0.001, respectively). Seven patients had the injured vessels repaired directly and all were prevented from amputation. In other patients who underwent vascular repair using a graft, vein graft (n = 20) showed a higher successful rate in salvage significantly than Gore-Tex graft (n = 9, P < 0.001). CONCLUSIONS Collateral circulation determines much of the fate of limb salvage in PAIs. As a result, a delayed revascularization could be accepted as long as there is existence of collateral circulation at the distal injured limb. An autologous vein graft is favored when a direct repair is not able to be performed for revascularization. Although fasciotomy was not found to be associated with a successful salvage in this study, its importance could not be neglected and it should be performed when there is an observed or impending compartment syndrome.
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Affiliation(s)
| | - Ma Dulce Lafuente Consuegra
- Section of Surgical Oncology, Department of General Surgery, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - Tsan-Shiun Lin
- From the Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
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Himura H, Uchida K, Hiyashita M, Mizobata Y. Successful limb salvage beyond the golden time following blunt traumatic open complete transection of the femoral artery and vein in a patient with cardiac arrest: a case report. Surg Case Rep 2021; 7:177. [PMID: 34347166 PMCID: PMC8339168 DOI: 10.1186/s40792-021-01264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Open complete transection of the femoral artery and vein following blunt trauma is extremely rare. Furthermore, even if the patient has been successfully resuscitated, it is sometimes difficult in most patients to preserve the injured limb, especially after damage control resuscitation. We report a case of open complete transection of the femoral artery and vein secondary to high-energy blunt trauma and a successful limb preservation treatment strategy. Case presentation A 57-year-old Asian man was transferred to hospital after having fallen from the 15th floor of a condominium. The patient was in cardiac arrest at the scene, but was successfully resuscitated by emergency medical services staff. On arrival, the patient’s hemodynamics were completely collapsed with active external bleeding from the thigh, so we immediately started resuscitation including activation of massive transfusion protocol and temporarily ligated the transected proximal superficial femoral artery, deep femoral artery just distal after branching lateral femoral circumflex artery and the superficial femoral vein. Following radiological findings showing a potential pelvic fracture with active bleeding, we also performed retroperitoneal packing in the resuscitation room and moved the patient to the angiography room for transcatheter arterial embolization. The patient’s consciousness was preserved and perfusion of the injured limb was barely maintained after his hemodynamics were adequately stabilized. As we detected weak perfusion of the lower limb via a potential collateral flow from the lateral femoral circumflex artery branches from deep femoral artery by pulse doppler of the dorsal pedis artery, we decided to reconstruct superficial femoral artery and vein at 24 h after injury using great saphenous vein bypass grafts. The patient was transferred to a rehabilitation hospital with good neurological and limb outcome after hospitalization for 52 days. Conclusion We successfully preserved the patient’s lower limb after cardiac arrest and complete transection of the femoral artery and vein and achieved a good neurological outcome. Even if a femoral artery needs to be ligated temporarily, careful observation and assessment should be performed so as not to lose the chance to salvage the limb even during damage control resuscitation.
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Affiliation(s)
- Hoshi Himura
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka City, 545-8586, Japan
| | - Kenichiro Uchida
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka City, 545-8586, Japan.
| | - Masahiro Hiyashita
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka City, 545-8586, Japan
| | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka City, 545-8586, Japan
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Ali G, Berlas MF, Din NU, Rehman KU, Muhammad Saleh W, Naqvi SAA. Outcomes of Revascularization and Factors Associated With Major Amputation in Patients With Lower Limb Arterial Injury: A Single-Center Retrospective Analysis. Cureus 2021; 13:e17290. [PMID: 34567854 PMCID: PMC8452226 DOI: 10.7759/cureus.17290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To identify the amputation rates and causative factors for failed revascularization leading to amputation in patients undergoing primary limb salvage procedures for lower-extremity vascular injuries. Methods This retrospective study was conducted at the vascular surgery department, Shaheed Mohtarma Benazir Bhutto (SMBB) Institute of Trauma, Karachi, Pakistan. The data were collected from hospital record using the non-probability sampling technique. Patients aged 17-70 years, undergoing primary revascularization during April 2016 to March 2021, were included in the study. Patients with crush injuries/non-salvageable limbs underwent primary amputation, isolated deep femoral artery or crural arteries (non-limb threatening) injuries, and non-traumatic injuries like intravenous drug-induced or iatrogenic injuries were excluded. The data analysis is done using SPSS Version 20.0 (IBM Corp., Armonk, NY, USA). A P-value of <0.05 was considered as significant. Results This study includes 56 patients of mean age 30.82 ± 9.29 years with male gender four times more affected than their counterpart. About 32% of patients were smokers, while 58% of patients had no co-morbidities. All patients presented with a mean time of 7.66 ± 1.69 hours of injury with an average of 1.14 arterial segments involved. The most frequent artery involved was popliteal artery (both above and below the knee), followed by superficial femoral artery injury constituting 50% and 26%, respectively, with arterial laceration and transection being common findings on exploration. Out of 56 patients, 27 (48.2%) had open fractures, 21 (37.5% ) closed fractures, and eight patients (14.3 % ) presented with dislocation as associated injuries. Following the procedure, secondary amputation was recorded in 18 (32.1%) patients. Thrombosis and infection were the leading causes of revascularization failure. Type of injury, segment of arterial injury, and associated bony injuries were associated with limb amputation. Conclusion Type and site of injury along with concomitant bony injuries are associated with major amputations after revascularization in lower-extremity arterial injuries.
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Affiliation(s)
- Ghulam Ali
- Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | | | - Najam U Din
- Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Khalil Ur Rehman
- Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
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Yu L, Deng L, Zhu S, Deng K, Yu G, Zhu C, Qi B, Pan Z. Limb-Salvage Outcomes of Arterial Repair Beyond Time Limit at Different Lower-Extremity Injury Sites. Med Sci Monit 2021; 27:e927652. [PMID: 33431786 PMCID: PMC7812700 DOI: 10.12659/msm.927652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The purpose of this study was to analyze the outcomes of revascularization exceeding 12 h after arterial injury at different sites of the lower extremity. Materal/Methods From January 2009 to April 2017, 58 patients with 58 lower-limb arterial injuries who underwent revascularization over 12 h after trauma were included in our study. Outcomes measured, including mortality, amputation, complications, and other parameters (gait, length discrepancy, the range of movement of the knee and ankle joint, and muscle wasting) were analyzed. Results External iliac artery injury (EIAI) or femoral artery injury (FAI) was affected in 4 patients, superficial femoral artery injury (SFAI) in 18, and popliteal artery injury (PAI) (including proximal gastrocnemius muscle vascular (PGMV) and proximal gastrocnemius muscle vascular [PGMV]) in 36. The median time of arterial injury was 72 h (interquartile range, 59.5). No mortality was found. Amputations were performed in 16 patients due to non-viable limbs, progressing infection, or muscle necrosis. All patients were followed up (median, 52 months; interquartile range, 5.5). Of the 42 limb-salvage patients, most had a limp, muscle wasting, or ankle and knee dysfunctions, and 26 patients with knee or ankle dysfunction underwent secondary surgery. Conclusions Although limited recanalization of blood vessels may lead to limb complications or amputations over time, the high success rate of limb salvage still merits the surgeon’s best efforts.
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Affiliation(s)
- Li Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Linglong Deng
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Shaobo Zhu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Kai Deng
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Guorong Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Chunquan Zhu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
| | - Zhenyu Pan
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China (mainland)
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Management for delayed and symptomatic pseudoaneurysm by iatrogenic popliteal artery injury during posterior cruciate ligament surgery. Asian J Surg 2020; 43:860-861. [PMID: 32439298 DOI: 10.1016/j.asjsur.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
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Parihar S, Benarroch-Gampel J, Teodorescu V, Ramos C, Minton K, Rajani RR. Vascular Surgeons Carry an Increasing Responsibility in the Management of Lower Extremity Vascular Trauma. Ann Vasc Surg 2020; 70:87-94. [PMID: 32422294 DOI: 10.1016/j.avsg.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/21/2020] [Accepted: 05/02/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is preliminary evidence that vascular surgeons are increasingly relied on nationally to assist with the management of lower extremity vascular trauma. Current trauma center verification, however, does not require any level of vascular surgery coverage. We sought to assess practice patterns regarding vascular surgery consultation and temporal trends in the surgical management of these patients. METHODS A retrospective analysis was performed on all patients who underwent surgical repair for vascular trauma of the lower extremity at a single, academic, public hospital from 2011 to 2018. Demographic data and procedural data were collected. Patients were assigned to a vascular surgery (VS) or nonvascular surgery (NV) group. The primary outcome measure was the rate of VS consultation. Secondary outcome measures included 30-day mortality, length-of-stay, and limb salvage. RESULTS One hundred eighty patients were identified (77 VS group, 103 NV group). There was an increase in the proportion of repairs done by VS from 2011 to 2018 (P < 0.05). There were significant management differences between the 2 groups, with vascular surgeons more likely to perform primary end-to-end anastomosis for both arterial (21.33% vs. 6.90%) and venous (19.15% vs. 5.26%) injuries (both P < 0.05). Patients in the VS group were less likely to have balloon embolectomy, fasciotomy, or intravascular shunting than the NV group (all P < 0.05). There were no significant differences in mortality (5.35% vs. 4.85%), length-of-stay (15.05 vs. 18.38 days), or limb salvage (94.81% vs. 95.15%). CONCLUSIONS Lower extremity vascular trauma is increasingly managed by vascular surgeons. Furthermore, vascular surgeons are more selective in the use of potentially unnecessary adjunctive maneuvers. Current accreditation guidelines should be revisited to mandate vascular surgery coverage in trauma centers that frequently treat this patient population.
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Affiliation(s)
- Sid Parihar
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Jaime Benarroch-Gampel
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Victoria Teodorescu
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Christopher Ramos
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Keri Minton
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Ravi R Rajani
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA.
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Shi E, Chen G, Qin B, Yang Y, Fang J, Li L, Wang Y, Zhu M, Yang J, Gu L. A novel rat model of tibial fracture for trauma researches: a combination of different types of fractures and soft tissue injuries. J Orthop Surg Res 2019; 14:333. [PMID: 31651336 PMCID: PMC6813134 DOI: 10.1186/s13018-019-1386-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The outcomes for open tibial fractures with severe soft tissue injury are still a great challenge for all the trauma surgeons in the treatment. However, most of the existing open tibial fracture models can only provide minimal soft tissue injury which cannot meet the requirement of severe trauma research. Our goal is to investigate a novel tibial fracture model providing different fractures combined with soft tissue injury for better application in trauma research. METHODS A total of 144 Sprague-Dawley rats were randomly divided into 4 groups. With group 1 as control, the other groups sustained different right tibial fractures by the apparatus with buffer disc settings either 3 mm, 10 mm, or 15 mm. X-ray and computed tomography angiography (CTA) were performed at 6 h to evaluate the fracture patterns and vascular injuries. Peripheral blood and tibialis anterior muscle were harvested at 6 h, 1 day, 3 days, 7 days, 14 days, and 28 days for ELISA and histological analysis. RESULTS X-ray and μCT results indicated that different fractures combined with soft tissue injuries could be successfully provided in this model. According to OTA and Gustilo classification, the fractures and soft tissue injuries were evaluated and defined: 36 type I in group 2, 34 type II in group 3, and 36 type III in group 4. The CTA confirmed no arterial injuries in groups 1 and 2, 2 arterial injuries in group 3, and 35 in group 4. ELISA indicated that the levels of pro-inflammatory cytokines TNF-α and IL-1β were significantly higher in group 4 than in other groups, and the levels of anti-inflammatory cytokines TGF-β and IL-10 were significantly higher in surgery groups than in group 1 in later stage or throughout the entire process. HE, Masson, and caspase-3 stains confirmed the most severe inflammatory cell infiltration and apoptosis in group 4 which lasted longer than that in groups 2 and 3. CONCLUSIONS The novel apparatus was valuable in performing different fractures combined with soft tissue injuries in a rat tibial fracture model with high reproducibility and providing a new selection for trauma research in the future.
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Affiliation(s)
- Enxian Shi
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Gang Chen
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Bengang Qin
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Yi Yang
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Jintao Fang
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Liang Li
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Yuanyuan Wang
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Menghai Zhu
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Jiantao Yang
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
| | - Liqiang Gu
- Department of Microsurgery & Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080 Guangdong People’s Republic of China
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Onakpoya UU, Eyekpegha JO, Ogunrombi A, Ohuche AS, Ojo TO. Pattern of Extremity Arterial Injury and Outcome of Repair in Southwest, Nigeria. Niger J Surg 2019; 25:85-90. [PMID: 31007519 PMCID: PMC6452751 DOI: 10.4103/njs.njs_18_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Extremity arterial injuries are an important cause of loss of life/limb after trauma. Early intervention is important for the good outcome. Objectives: The objective of this study is to review the pattern of presentation and study the factors that influences the outcome of extremity arterial injuries in our hospital. Patients and Methods: This is a retrospective study of all patients with injuries to the extremity arteries requiring surgical intervention from July 2007 to June 2015. Data obtained included biodata, ischemic time, arteries involved, surgical intervention, and outcomes and analyzed using SPSS version 22. Setting: Our hospital is the main referral hospital for vascular trauma serving four adjoining states in Nigeria and is linked to major cities by at least 3 Trunk-A federal roads. Subjects: The subjects are patients who were managed in our cardiovascular surgical unit for the study duration (July 2007–June 2015) who had extremity arterial injuries. Results: A total of 36 patients presenting with 40 arterial injuries in 37 limbs were studied. The mean age was 28.4 ± 10.3 years with male preponderance (88.9%). Gunshot injuries were the most common cause of arterial injuries (37.8%), followed by assault (27%). The mean time from injury to presentation for acute injuries was 20.4 h but 23 of the patients (63.8%) presented to the accident and emergency department within 12 h of injury. A limb salvage rate of 64.9% was achieved though ischemic times of ≥12 h were associated with poor outcomes. Conclusion: Prolonged ischemic time is associated with poor outcomes. Efforts should be put in place to reduce the limb ischemic times.
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Affiliation(s)
| | | | | | - Akumbu Sylva Ohuche
- Department of Otorhinolaryngology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
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Lebowitz C, Matzon JL. Arterial Injury in the Upper Extremity: Evaluation, Strategies, and Anticoagulation Management. Hand Clin 2018; 34:85-95. [PMID: 29169600 DOI: 10.1016/j.hcl.2017.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Trauma to the upper extremity can present with an associated arterial injury. After patient stabilization, thorough assessment with physical examination and various imaging modalities allows accurate diagnosis of the specific arterial injury. After diagnosis, efficient treatment is necessary to allow limb salvage. Treatment options include ligation, primary repair, graft reconstruction, endovascular repair, and amputation. The final treatment rendered is frequently dependent on injury location and mechanism. With any of the treatment options, complications may occur, including thrombosis. Currently, no validated anticoagulation protocol has been established for managing arterial injuries in the upper extremity.
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Affiliation(s)
- Cory Lebowitz
- Department of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 080084, USA
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Wang E, Inaba K, Cho J, Byerly S, Rowe V, Benjamin E, Lam L, Demetriades D. Do Antiplatelet and Anticoagulation Agents Matter after Repair of Traumatic Arterial Injuries? Am Surg 2016. [DOI: 10.1177/000313481608201024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thrombosis is a devastating complication after repair of traumatic vascular injury. Although thrombosis rates have been described, the value of anticoagulation in preventing postrepair thrombosis is unknown. We hypothesize that postoperative anticoagulation reduces thrombosis rates. A total of 1524 consecutive patients with traumatic arterial injuries from January 2005 to June 2015 were identified, and 381 patients underwent the following repair types: direct suture of vessel wall, primary anastomosis, extra-anatomic reconstruction, tissue and synthetic interposition reconstruction. Twenty six patients received postoperative heparin at therapeutic levels, and 29 patients received postoperative aspirin for five consecutive days. The heparin and aspirin groups were matched with patients without postoperative anticoagulation by the following variables: anatomic arterial injury, type of vascular repair, and age. These groups were then compared using the following outcome measures: mortality, thrombosis of repaired vessel, amputation, hemorrhage, cerebral vascular accident, and extremity compartment syndrome. The demographics between the heparin, aspirin, and respectively matched groups were not statistically different. There was no statistically significant difference in the rate of thrombosis, bleeding, compartment syndrome, cerebral vascular accident, limb amputation, or mortality. Although there was no increase in bleeding complications with the use of heparin or aspirin, there was also no impact on the rate of thrombosis.
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Affiliation(s)
- Eugene Wang
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Jayun Cho
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Saskya Byerly
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Vincent Rowe
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Elizabeth Benjamin
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Lydia Lam
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
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14
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Yan H, Maximus S, Koopmann M, Keeley J, Smith B, Virgilio CD, Kim DY. Vascular Trauma Operative Experience is Inadequate in General Surgery Programs. Ann Vasc Surg 2016; 33:94-7. [DOI: 10.1016/j.avsg.2016.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
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15
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Retrospective analysis of case series of patients with vascular war injury treated in a district hospital. Injury 2016; 47:811-7. [PMID: 26948690 DOI: 10.1016/j.injury.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the Syrian civil war continues, medical care of the injured remains a priority for health facilities receiving casualties. Ziv Medical Centre, the closest hospital in Israel to the Syrian border, has received 500 casualties since February 2013. Seventeen of these patients had vascular injuries. This research reports the care of these seventeen patients and explores the challenges of treatment in patients with little antecedent clinical history and improvised initial care that may be complicated by delay to definitive care, sepsis and limb ischaemia. METHOD Electronic and paper patient records were examined. Descriptive case series data are presented. RESULTS Fifteen of the 17 patients were male. The mean age was 20 years (range 8-30 years). Causes of injury included gunshot wounds (4 patients), shrapnel (multi-fragment) injury (12 patients), and 1 patient was run over and dragged behind a car. The time from injury to transfer to definitive care ranged from 5h to 7 days (mean 43 h). All but one patient had associated non-vascular multiple-trauma. Thirteen patients presented with limb ischaemia. Four patients had arterio-venous fistula (AVF) or pseudoaneurysm. There were 5 upper and 10 lower limb major vascular injuries. Three patients had neck vessel injuries. All patients were investigated with CT angiography and underwent surgical or endovascular intervention. In 12 patients, 4 vessels were debrided and re-anastomosed and 13 vessels bypassed. Endovascular repair was performed in 4 patients. After initial revascularisation, 4 patients went on to amputation. There were no deaths. CONCLUSIONS The injuries treated are heterogeneous, and reflect the range of high energy vascular trauma expected in conflict. The broad range of vascular solutions required to optimise outcomes, in particular, limb salvage, in turn, reflect the challenges of dealing with such injuries, especially within the context of sepsis, ischaemia and delay. As war continues, there is a pressing need to address the needs of patients with high energy injuries in austere environments where there is a dearth of health resources and where definitive care may be days away.
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Karnes JM, Bravin DA, Hubbard DF. Axillary artery compression as a complication of a shoulder dislocation. J Shoulder Elbow Surg 2016; 25:e61-4. [PMID: 26927436 DOI: 10.1016/j.jse.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/25/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Jonathan M Karnes
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA.
| | - Daniel A Bravin
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - David F Hubbard
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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17
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Sun YF, Fang QX, Zhan HY, Wang F, Cao W, Zhao G. Outcome Assessments of Patients with Posttraumatic "Ultra-Time Vascular Injuries" of the Extremities. Sci Rep 2015; 5:17913. [PMID: 26639214 PMCID: PMC4671146 DOI: 10.1038/srep17913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022] Open
Abstract
The management of posttraumatic vascular injury that presents after 8 h, or “ultra-time vascular injury”, is daunting, and inciting recognition of this injury is vital. We retrospectively analyzed 29 patients with ultra-time vascular injuries to determine the patients’ demographic characteristics and identify the determinants for amputation and disability. The age distribution of the high-risk population was from 18 years to 40 years, which indicated that these patients had plenty of productive life remaining. Injuries to the lower limbs (79.31%) were over four times more common than injuries to the upper limbs (17.24%), and open and blunt injuries occurred most commonly. The overall rate of limb salvage was 82.76% (24/29) and limb function is excellent in 45.83% (11/24) of the patients. The remaining patients experienced different degrees of disability in their limbs, which was determined by the anatomic location of the injury, and the presence of a combined arterial and venous injury, nerve injury, and complex soft tissue injury, as well as the occurrence of compartment syndrome. Hence, we recommend limb-salvage treatment for patients with traumatic ultra-time vascular injuries, particularly for those aged between 18 years and 40 years. Furthermore, we encourage the development of limb-salvage techniques for ultra-time vascular injuries.
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Affiliation(s)
- Yi-Feng Sun
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
| | - Qiong-Xuan Fang
- Liver Disease Department of the Second Hospital of Shandong University (SHSU), Beiyuan Road 247, Jinan, Shandong 250033, PR China
| | - Hong-Yan Zhan
- The Fourth Hospital of Jinan city, Jinan, Shandong, 250031, PR China
| | - Fan Wang
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
| | - Wei Cao
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
| | - Gang Zhao
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
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Hanifah J, Paiman M, Nawfar AS, Tengku-Muzaffar T, Wan-Azman WS, Faisham WI, Sahran Y. Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries. Malays Orthop J 2015; 9:61-64. [PMID: 28611914 PMCID: PMC5393139 DOI: 10.5704/moj.1511.014] [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] [Indexed: 11/05/2022] Open
Abstract
High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.
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Affiliation(s)
- J Hanifah
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M Paiman
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - A S Nawfar
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Tms Tengku-Muzaffar
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W S Wan-Azman
- Plastic Reconstructive Unit, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W I Faisham
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Yahya Sahran
- Department of Orthopaedic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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