Skip to main content
SpringerLink
Log in

Penetrating Extremity Trauma

  • Surgical Symposium Contribution
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Penetrating extremity trauma (PET) usually becomes less important when present along with multiple truncal injuries. The middle eastern wars documented the terrible mortality and morbidity resulting from PET. Even in civilian trauma, PET can lead to significant morbidity and mortality. There are now well-established principles in the evaluation and management of vascular, bony, soft tissue, and neurologic lesions that will lead to a reduction of the poor outcomes. This review will summarize some of these recent concepts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dorlac WC, DeBakey ME, Holcomb JB et al (2005) Mortality from isolated civilian penetrating extremity injury. J Trauma 59:217–222

    Article  CAS  PubMed  Google Scholar 

  2. Feliciano DV (2010) Management of peripheral arterial injury. Current Opin Crit Care 16:602–608

    Article  Google Scholar 

  3. Halvorson JJ, Anz A, Langfitt M et al (2011) Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg 2011(19):495–504

    Google Scholar 

  4. Dennis JW, Frykberg ER, Veldenz HC et al (1998) Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating extremity trauma: 5- to 10-year follow-up. J Trauma 44(2):243–252

    Article  CAS  PubMed  Google Scholar 

  5. Passos E, Dingley B, Smith A et al (2014) Tourniquet use for peripheral vascular injuries in the civilian setting. Injury 45(3):573–577

    Article  PubMed  Google Scholar 

  6. Welling D, Burris D, Hutton J et al (2006) A balanced approach to tourniquet use: lessons learned and relearned. J Am Coll Surg 203:106–115

    Article  PubMed  Google Scholar 

  7. Johansen K, Lynch K, Paun M, Copass M (1991) Non-invasive vascular tests relibly exclude occult arterial trauma in injured extremities. J Trauma 31(4):515–519

    Article  CAS  PubMed  Google Scholar 

  8. Bynoe RP, Miles WS, Bell RM et al (1991) Noninvasive diagnosis of vascular trauma by duplex ultrasonography. J Vasc Surg 14:346–352

    Article  CAS  PubMed  Google Scholar 

  9. Patterson BO, Holt PJ, Cleanthis M et al (2012) Imaging vascular trauma. Br J Surg 99(4):494–505

    Article  CAS  PubMed  Google Scholar 

  10. Van Waes OJ, Van Lieshout EM, Hogendoorn W, Halm JA, Vermeulen J (2013) Treatment of penetrating trauma of the extremities: ten years’ experience at a dutch level 1 trauma center. Scand J Trauma ResuscEmerg Med 14:21:2

  11. Wallin D, Yaghoubian A, Rosing D, Walot I, Chauvapun J, de Virgilio C (2011) Computed tomographic angiography as the primary diagnostic modality n penetrating lower extremity vascularinjuries: a level I trauma experience. AnnVasc Surg 25(5):620–623

    Google Scholar 

  12. Inaba K, Branco BC, Reddy S, Park JJ, Green D, Plurad D, Talving P, Lam L, Demetriades D (2011) Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma 70(4):808–815

    Article  PubMed  Google Scholar 

  13. Feliciano DV, Moore FA, Moore EE et al (2011) “Western trauma association critical decisions in trauma: evaluation and management of peripheral vascular injury Part I. J Trauma 70:1551–1556

    Article  PubMed  Google Scholar 

  14. Mattox KL, Feliciano DV, Burch J et al (1989) Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. epidemiologic evolution 1958–1987. Ann Surg 209:698–707

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. McHenry TP, Holcomb JB, Aoki N et al (2002) Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma 53:717–721

    Article  PubMed  Google Scholar 

  16. Ball CG, Feliciano DV (2009) A simple and rapid vascular anastomosis for emergency surgery: a technical case report. World J Emerg Surg 4:30–32

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ledgerwood AM, Lucas CE (1975) Biological dressings for exposed vascular grafts: a reasonable alternative. J Trauma 15:567–574

    Article  CAS  PubMed  Google Scholar 

  18. Rasmussen TE, Clouse WD, Jenkins DH et al (2006) The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma 61:8–15

    Article  PubMed  Google Scholar 

  19. Subramanian A, Vercruysse G, Dente C et al (2008) A decade’s experience with temporary intravascular shunts at a civilian level I trauma center. J Trauma 65:316–326

    Article  PubMed  Google Scholar 

  20. Taller J, Kamdar JP, Greene JA et al (2008) Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at echelon II facilities? J Trauma 2008(65):595–603

    Article  Google Scholar 

  21. Feliciano DV, David V et al (2013) Western trauma association critical decisions in trauma: evaluation and management of peripheral vascular injury, part II. J Trauma Acute care surg 75(3):391–397

    Article  PubMed  Google Scholar 

  22. Worni M, Scarborough JE, Gandhi M et al (2013) Use of endovascular therapy for peripheral arterial lesions: an analysis of the national trauma data bank from 2007 to 2009. Ann Vasc Surg 27(3):299–305

    Article  PubMed  Google Scholar 

  23. Franz RW, Skytta CK, Shah KJ et al (2012) A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg 26(5):655–664

    Article  PubMed  Google Scholar 

  24. Eastern association of surgery of trauma: PMG : penetrating venous extremity trauma, management of east.org Accessed 5 May,2014

  25. Ivatury RR (2014) Presure, perfusion and compartments (2014): challenges for the acute care surgeon. J Tr Acute Care Surg 76(6):1341–1348

    Article  Google Scholar 

  26. Scalea TM, DuBose J, Moore EE et al (2012) Western Trauma Association critical decisions in trauma: management of the mangled extremity. J Trauma Acute Care Surg 72(1):86–93

    Google Scholar 

  27. de Mestral C, Sharma S, Haas B et al (2013) A contemporary analysis of the management of the mangled lower extremity. J Trauma Acute Care Surg 74(2):597–603

    Article  PubMed  Google Scholar 

  28. Miller KR, Benns MV, Sciarretta JD et al (2011) The evolving management of venous bullet emboli: a case series and literature review. Injury 42(5):441–446

    Article  PubMed  Google Scholar 

  29. Shannon FL, McCroskey BL, Moore EE et al (1987) Venous bullet embolism: rationale for mandatory extraction. J Trauma 27(10):1118–1122

    Article  CAS  PubMed  Google Scholar 

  30. Nolan T, Phan H, Hardy AH et al (2012) Bullet embolization: multidisciplinary approach by interventional radiology and surgery. Semin Intervent Radiol 29(3):192–196

    Article  PubMed Central  PubMed  Google Scholar 

  31. Jacobs LM, McSwain NE, Rotondo MF et al (2013) Improving survival from active shooter events: the hartford consensus. J Trauma Ac Care Surg 74:1399

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA

    Rao R. Ivatury & Rahul Anand

  2. Trauma and Critical Care, Department of Surgery, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia

    Carlos Ordonez

Authors
  1. Rao R. Ivatury
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Anand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlos Ordonez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rao R. Ivatury.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ivatury, R.R., Anand, R. & Ordonez, C. Penetrating Extremity Trauma. World J Surg 39, 1389–1396 (2015). https://doi.org/10.1007/s00268-014-2865-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2865-8

Keywords

Search

Navigation