Reconstructive Surgery of Civilian and Military Missile Penetrating Vascular Injuries

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• 作者：Avramov ; S. ; Vukobratov ; V. ; Kovacevic ; P. ; Pfau ; J. ; Petrovic ; P. ; Obradovic ; J.
• 刊名：Cardiovascular Surgery
• 出版年：1995
• 出版时间：September, 1995
• 年：1995
• 卷：3
• 期：Complete
• 页码：10
• 全文大小：77.5 K

文摘

This study reviewed five years single center experience of civilian and military missile penetrating vascular injuries, treated by surgical repair. From January 1990 to November 1994, the number of (726) injured patients with missile lesions was admitted and treated to the University Surgical Clinic in Novi Sad and among them there were 57 patients (7.85 % ) with 59 vascular related wounds and total of 88 penetrating vascular lesions-59 arterial (67 % ) and 29 venous (33 % ). Femoro-popiteal and axillobrachial segment with 32.3 % and 20.3 % of the total arterial injuries and poplitero-femoral segment with 44.8 % of total venous injuries, were often involved. One third of vascular related wounds were associated with open bone fractures. The results of revascularisation were analyzed in function of following criteria: success of medical pretreatment, duration of transportation time, type of wounds according to amount of tissue damage and injured structures, scored by the Red Cross Wound Classification System (RCWCS) and sequences of surgical procedures during vascular repair. All of the patients were in different stages of hemorrhagic shock due to inadequate pretreatment. The transportation time ranged from 1.5 to 16 hours (mean 4.5). According to RCWCS, there were 42 vascular related TYPE V wounds (71.2 % ) and 17 vascular related TYPE VF wounds (28.8 % ), both distributed equally in Grade 1 (low energy transfer) and Grade 2 (high energy transfer) wounds. All vascular lesions were reconstructed using autologous venous graft, except one extra anatomic synthetic graft repair. Mean implantation time was 2 hours and all repairs were performed without previous angiography and use of temporary shunts. Simultaneous fasciotomies were done in more than half of the patients. Associated open bone fractures were managed by external fixation after vascular repair. Early results were good with neurological disfunctions in one third of patients. Three secondary amputations (5.3 % ) had been performed because of sepsis, deep vein thrombosis and extensive myonecrosis. Mortality rate was 10.55, mostly caused by consequences of severe hemorrhage before repair.