Vascular injuries in extremities]

Vascular injuries of the extremities account for most instances of vascular trauma (ca. 70%), and they entail a risk of amputation about 10-20%. According to the kind of force that has acted, arterial trauma is classified as direct or indirect. The scale of hemorrhage and peripheral ischemia depend on the nature and severity of the arterial lesion. In patients with multiple injuries, routine use of Doppler sonography and duplex sonography can facilitate early diagnosis and treatment of vascular injuries. With great certainty, clinical examination and an AB or WB index of >1.0 can rule out the presence of vascular injury that requires treatment. After excluding further life-threatening injuries, surgery should be performed immediately when there is critical ischemia, squirting hemorrhage, or a rapidly expanding hematoma. Angiography or duplex sonography findings determine the further procedure in vascular injuries that do not require immediate treatment. Occlusion of a reconstructed artery, manifestation of a compartment syndrome, and insufficient anticoagulation are the main factors affecting the risk of amputation.     

Vascular injuries of the extremities: hazards of unnecessary delays in diagnosis

Delay in the diagnosis of vascular injuries of the extremities is still considered acceptable practice by many, despite its inherent high risk of morbidity and permanent disability. Such practice must be discouraged, because vascular wounding can be diagnosed early and with great precision by angiography. The arteriogram should become part of the initial emergency room assessment of all patients who sustain penetrating injuries of the extremities, as well as those who suffer violent blunt extremity trauma.     

Causes of death in battle casualties reaching hospitals

Data are presented on the number of men dying on the battle-field as compared to those who die after they reach a hospital. The inverse variation in these two figures is demonstrated. Data are then presented on 86.5 per cent of all the American battle casualty deaths occurring in Fifth Army Hospitals in Italy from January 1, 1944, to May 2, 1945. A classification of these cases as to location of principal wounds and as to immediate cause of death is made. The importance of shock, neural damage, kidney complications, lung complications, embolism and other factors as immediate or precipitating causes of death is elaborated.     

Vascular trauma of the upper extremities

The aim of this study was to evaluate short- and long-term results of the treatment of upper extremities vascular trauma considering aetiology of the lesions, percentage of limb salvage and residual functional disability. The Authors retrospectively evaluated 17 patients accounting for 21 vascular lesions of the upper extremities (16 arterial and 5 venous injuries). Age, sex, modality of trauma, site of the vascular lesions and of the associated injuries, diagnostic procedures at the admission, ischemic time, arterial and venous repair performed were analyzed. The over all peri-operative mortality was 5.8%. Of the 16 arterial injuries long-term reconstruction viability was obtained in 15 patients (93.7%). In all cases limb salvage was obtained. In 3 patients invalidating functional defects due to associated injuries of the major brachial plexus were observed. The Authors believe that associated nervous lesions are the main factor determining invalidating residual disability. In this series ischemic time, technique of vascular repair performed, associated skeletal injuries didn't influence the functional outcome of the reconstruction.