Abstract
Our experience with 118 patients who underwent surgery for a total of 178 popliteal vessels injuries is reported. Forty-nine per cent had injury to both artery and vein and 44% had associated bony fractures. Fourteen patients subsequently needed amputation for a rate of 11.9%. There were no deaths. Delay in repair (>6 hours from injury), associated fractures, and a shocked condition resulted in increased limb loss. Arterial as well as venous repair, external skeletal fixation, and fasciotomy when necessary lead to improved limb salvage.
Résumé
Notre expérience concerne 118 patients opérés au total de 178 lésions dex vaisseaux poplités. Quarante-neuf pour cent de ces patients avaient á la fois une lésion de l'artère et de la veine poplitées alors que 44% avaient une fracture associée. Quatorze patients (11.9%) ont eu besoin d'une amputation secondaire. Augmentaient le risque d'amputation: un délai entre l'accident et l'intervention supérieur à 6 heures, des fractures associées et un état de choc. La reconstruction artérielle et veineuse simultanée, une fixation osseuse externe et une aponévrotomie, lorsqu'elles étaient nécessaires, diminuent le risque d'amputation.
Resumen
Las lesiones de la arteria ploplítea todavía se asocian con las más altas tasas de amputación, especialmente cuando se acompañan de fracturas mayores; publicaciones recientes sobre lesiones occuridas en la vida civil y en la militar reportan tasas entre 0% y 42%. El presented estudio revisa la experiencia en la Universidad Americana de Beirut del Centro Médico de Beirut con lesiones traumáticas de los vasos ploplíteos por proyectiles de alta velocidad en un período de 16 años de la guerra en el Líbano, entre enero de 1975 y diciembre de 1990. Se informa nuestra experiencia con 118 pacientes operados, para un total de 178 lesiones de los vasos ploplíteos; 49% presentaron lesiones conjuntas de la vena y de la arteria y 44% sufrieron fracturas asociadas. Catorce pacientes requirieron amputación ulterior, para una tasa de 11.9%. No hubo muertes. La demora en iniciar la reparación quirúrgica (más de 6 horas desde el momento de la lesión), la presencia de fracturas asociadas y el shock fueron factores determinantes de incremento en la pérdida de la extremidad. Con la reparación arterial y venosa, la fijación ósea y la fasciotomía, en casos seleccionados, se logró incrementar la tasa de salvamento de la extremidad afectada.
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Sfeir, R.E., Khoury, G.S., Haddad, F.F. et al. Injury to the popliteal vessels: The Lebanese war experience. World J. Surg. 16, 1156–1159 (1992). https://doi.org/10.1007/BF02067087
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DOI: https://doi.org/10.1007/BF02067087