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Advances in treatment of vascular injuries from blunt and penetrating limb trauma

  • World Progress In Surgery
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Abstract

Military and civilian experience has contributed to the current state of the art in management of extremity vascular injuries. Thorough physical examination and judicious use of emergency center arteriography and formal arteriography provide means for prompt diagnosis and treatment which is critical is limb loss and disability are to be avoided. Prosthetic graft material has provided an alternative to vein grafting in many circumstances for arterial and venous injuries. Compartment syndrome should be anticipated when an ischemic extremity is revascularized and fasciotomy should be used liberally. Vascular repairs are the first priority in extremity wounds, but associated injuries to bones, joints, soft tissues, and nerves are often critical determinants of rehabilitation once blood supply has been re-established. The best results are obtained when a multidisciplinary approach is used combining expertise in orthopedic surgery, neurosurgery, and plastic surgery.

Résumé

Nos connaissances actuelles sur le traitement des lésions vasculaires des extrémités ont beaucoup progressé grâce à l'expérience acquise en pratique militaire et civile. Un examen complet et l'utilisation judicieuse d'un service de traumatologie avec possibilité d'artériographie sont des moyens certains pour faire rapidement le diagnosticet assurer le traitement si on veut éviter la perte ou des lésions irréverisbles d'un membre. Il est possible d'utiliser les prothèses pour remplacer une artère ou une veine au lieu d'une greffe veineuse. Un syndrome des loges est à anticiper lors de la revascularisation d'une extrémité ischémique et les indications des aponévrotomies doivent être larges. La réparation vasculaire est prioritaire dans ces lésions combinées, mais la présence de lésions associées des os, des articulations, des parties molles et des nerfs sont autant de facteurs indiquant de longs mois de rééducation une fois que la circulation aura été rétablie. Les meilleurs résultats sont le fait d'une approche multidisciplinaire, en combinant les qualités chirurgicales des spécialistes en orthopédie, en neurochirurgie et en chirurgie réparatrice.

Resumen

La experiencia militar y civilihan contribuido al actual estado del arte en el manejo de las lesiones vasculares de las extremidades. Mediante el examen físico y con el uso racional de la arteriografía en el centro de urgencias y de la arteriografía formal, se obtiene información para el establecimiento temprano del diagnóstico la iniciación precoz del tratamiento, lo cual es de importancia crítica para evitar la pérdida de la extremidad afectada y la correspondiente incapacidad. Las prótesis vasculares proveen una alternativa al injerto venoso en muchos casos de lesiones arteriales y venosas. Cuando una extremidad es revascularizada, debe esperarse la aparición del síndrome de compartimiento, en cuyo manejo se utiliza liberalmente la fasciotomía. Las reparaciones vasculares constituyen la primera prioridad en el tratamiento las heridas de las extremidades, pero las heridas asociadas de huesos, articulaciones, tejidos blandos y nervios con frecuencia revisten importancia crítica como factores determinantes de rehabilitación, una vez restablecida la circulación. Se obtienen los mejores resultados cuando se utiliza un aproche multidisciplinario que combine conocimientos en cirugía ortopédica, neurocirugía, y cirugía plástica.

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Authors and Affiliations

  1. Department of Surgery, Baylor College of Medicine and The Ben Taub General Hospital, Houston, Texas, USA

    R. Russell Martin M.D., Kenneth L. Mattox M.D., Jon M. Burch M.D. & Robert J. Richardson M.D.

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  1. R. Russell Martin M.D.
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  2. Kenneth L. Mattox M.D.
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  3. Jon M. Burch M.D.
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  4. Robert J. Richardson M.D.
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Russell Martin, R., Mattox, K.L., Burch, J.M. et al. Advances in treatment of vascular injuries from blunt and penetrating limb trauma. World J. Surg. 16, 930–937 (1992). https://doi.org/10.1007/BF02066994

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