Analysis of peripheral vascular injuries: A social catastrophe

Öz

Objective: In the current study, peripheral vascular injuries caused from weapons and the associated clinical outcomes were retrospectively investigated. Methods: Two hundred patients who received a surgical procedure for a vascular injury between January 2009 and December 2011 were included in the study. The patients were evaluated retrospectively; type of injury, localization, characteristics, and type of surgical application were classified. Results: Weapon-related penetrating injuries were classified as gunshot injuries (n=55, 28%), stab wounds (n = 143, 71%), and mine injuries (n= 2, 1%). There were 77 interposition applications (71 arterial and 6 venous) with saphene vein grafts, 16 arterial interposition applications with polytetrafluoroethylene grafts, and 11 venous ligations. A total of 170 direct repairs (134 arterial and 36 venous) were performed. Postoperative amputation was required in none of the cases, advanced intensive care unit follow-up was required for four patients (2%; two cases were referred with hypovolemic shock and two case were referred with asystole), and a postoperative follow-up period for any mortality was not observed. Conclusion: Some regions contain higher levels of war injuries. Therefore, these regions require specialized intervention centres. A large amount of these injuries are vascular, and surgery and rapid interventions are essential for reducing mortality and morbidity rates. Successful results can be obtained in these cases through the collaboration of various medical disciplines.

Anahtar Kelimeler

• Peripheral vascular injuries, war surgery, collaborative management

Periferik damar yaralanmaları analizi: Sosyal bir katastrofi

Öz

Giriş: Bu çalışmada, silahların neden olduğu vasküler yaralanmalar ve ilgili klinik sonuçları retrospektif olarak araştırıldı. Yöntemler: Ocak 2009 ile Aralık 2011 yılları arasında vasküler yaralanma nedeniyle cerrahi prosedür uygulanan 200 hasta çalışmaya dahil edildi. Hastalar retrospektif olarak değerlendirilerek; yaralanma tipi, lokalizasyonu, karakteristikleri ve cerrahi uygulama şekli açısından sınıflandırıldı. Bulgular: Silah ilişkili penetran yaralanmalar ateşli silah yaralanması (n= 55, %28), kesici delici alet yaralanması (n=143, %71) ve mayın yaralanması olarak (n=2, %1) sınıflandırıldı. Yetmiş yedi safen ven ile interpozisyon uygulaması (71 arteryal and 6 venöz), 16 polytetrafloroetilen ile arteryal interpozisyon uyuglaması ve 11 ven ligasyonu mevcuttu. Toplam 170 (134 arteryal and 36 venöz) direk onarım uygulandı. Hiçbir olguda ameliyat sonrası amputasyon gerekmezken, 4 (%2; 2 hasta hipovoloemik şok ve 2 hasta da asistol ile ilgili olarak) hastada yoğun bakım ünitesi takibi gerekti ve ameliyat sonrası izlem süresinde mortalite gözlenmedi. Sonuçlar: Bazı bölgeler yüksek düzeyde savaş yaralanmalarına sahiptir. Bu nedenle, bu bölgeler özelleşmiş müdahale merkezlerine ihtiyaç duyarlar. Bu yaralanmaların çoğu damarsaldır ve cerrahi ve hızlı girişimler mortalite ve morbidite oranlarını düşürmek için esastır. Bu vakalarda birçok medikal disiplinin ortak çalışması ile başarılı sonuçlar elde edilebilir.

Anahtar Kelimeler

• Periferal vasküler yaralanmalar, savaş cerrahisi, işbirlikçi yönetim

Kaynakça

1. National Center for Injury Control and Prevention, Centers for Disease Control and Prevention. Web-based injury sta- tistics query and reporting system, http://www.cdc.gov/in- jury/wisqars/index.html, Accessed December 3, 2013.
2. Austin OM, Redmond HP, Burke PE, et al. Vascular trauma - A review. J Am Coll Surg 1995;181:91-108.
3. Mattox KL, Feliciano DV, Burch J, et al. Five thousand seven hundred sixty cardiovascular injuries in 4459 pa- tients. Epidemiologic evolution 1958 to 1987. Ann Surg. 1989;209:698-705; discussion 706-707.
4. Golledge J, Scriven MW, Fligelstone LJ, Lane IF. Vas- cular trauma in civilian practice. Ann R Coll Surg Engl 1995;77:417-420.
5. Wyme OW, Richardson DT, Dodson GE. Cases of gunshot wounds of Mesopotamia. Br Med J 1916;2;789-794
6. Tünerir B, Beşoğul Y, Yavuz T, et al. Periferik arteriyel yaralanmalar ve tedavi sonuçları. Turkish J Thorac Cardio- vasc Surg 1998;6:151-154.
7. Bridges E, Biever K. Advancing critical care: Joint combat casualty research team and joint theater trauma system. AACN Adv Crit Care. 2010;21:260-76.
8. Thorey F, Stukenborg-Colsman C, Windhagen H, Wirth CJ. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee ar- throplasty: a prospective randomized study.Technol Health Care. 2008;16:85-92.

9. Dennis JW, Frykberg ER, Veldenz HC, et al. Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrat- ing extremity trauma: 5- to 10-year follow-up. J Trauma 1998;44:243-252.
10. Gillespie DL, Woodson J, Kaufman J, et al. Role of arte- riography for blunt or penetrating injuries in proximity to major vascular structures: An evolution in management. Ann Vasc Surg 1993;7:145-149.
11. Ramanathan A, Perera DS, Sheriffdeen AH. Emergency femoral arteriography in lower limb vascular trauma. Cey- lon Med J 1995;40:105-106.
12. Rozycki G, Tremblay LN, Feliciano DV, McClelland WB. Blunt vascular trauma in the extremity: Diagnosis, manage- ment, and outcome. J Trauma. 2003;55:814-824.
13. Ben-Menachem Y. Vascular injuries of the extremities: Hazards of unnecessary delays in diagnosis. Orthopedics. 1986;9:333-338.
14. Menzoian JO, Doyle JE, Cantelmo NL, et al. A compre- hensive approach to extremity vascular trauma. Arch Surg 1985;120:801-805.
15. Morales-Uribe CH, Sanabria-Quiroga AE, Sierra-Jones JM. Vascular trauma in Colombia: Experience of a level I trau- ma center in Medellín. Surg Clin North Am 2002;82:195- 210.
16. Menakuru SR, Behera A, Jindal R, et al. Extremity vascu- lar trauma in civilian population: A seven-year review from North India. Injury 2005;36:400-406.
17. Burma O, Uysal A, Özsin KK, et al. Periferik damar yaralanmalarında cerrahi deneyimimiz: 175 olgunun değerlendirilmesi. Turkish J Thorac Cardiovasc Surg 2005;13:252-254.
18. Giannoukas AD. Lower limb revascularization with infra- genicular bypass using PTFE graft and the distal vein patch technique: Does it confer any advantage over the distal vein cuff techniques? Eur J Vasc Endovasc Surg 2012;44:183- 184.
19. Taylor RM, Sullivan MP, Mehta S. Acute compartment syndrome: Obtaining diagnosis, providing treatment, and minimizing medicolegal risk. Curr Rev Musculoskelet Med 2012;5:206-213.
20. Galindo RM, Workman CR. Vascular trauma at a military level II trauma center. Curr Surg 2000;57:615-618.