腘血管不同平面损伤的临床意义

[目的]分析和总结腘血管损伤患者中不同损伤平面的临床特点,提高该损伤的临床认识和诊疗水平。[方法]回顾2014年1月～2016年12月本院收治的54例腘血管损伤患者,男43例,女11例,年龄6.5～75岁,平均(42.08±15.04)岁。分析患者的伤因、血管损伤平面、肢体缺血时间、手术方法、手术次数和随访时肢体功能等临床指标。[结果]据血管影像资料,损伤平面位于腘动脉发出腓肠动脉分支以上者(高位组) 12例,位于腘动脉发出腓肠动脉分支以下者(低位组) 42例。高位组12例,血管修复9例(术后溶栓2例),保肢成功9例,截肢3例,平均手术3.92次/例,保肢患者肢体功能优良率22.22%;损伤平面在腓肠动脉以下的患者(低位组) 42例,血管修复36例(术后溶栓3例),单纯溶栓治疗5例,保肢成功39例,一期截肢1例,二期截肢2例,平均手术2.91次/例,保肢患者肢体功能优良率66.67%。高位组患者在保肢率、保肢后肢体功能优良率等指标上显著差于低位组,两组差异有统计学意义(P0.05)。[结论]损伤平面在腓肠动脉分支平面以下者,保肢率及肢体功能明显优于损伤平面在腓肠动脉以上的患者。腓肠动脉的侧支代偿作用是腘血管不同损伤平面临床差异的主要原因。     

膝部骨折脱位合并腘动脉损伤21例

[目的]回顾性分析膝部骨折脱位合并腘动脉损伤的治疗方法和效果.[方法]本组21例,男17例,女4例;年龄16-68岁,平均34.3岁.骨折脱位情况膝关节脱位2例,股骨下端骨折4例,胫骨上端骨折9例,浮膝6例.动脉修复方法端端吻合7例,大隐静脉移植14例.骨折及脱位固定方法石膏固定2例,内固定14例,外固定架固定5例.修复顺序2例膝关节脱位合并腘动脉损伤的患者先手法复位膝关节再修复血管,膝部骨折合并胭动脉损伤的患者先修复血管,后固定骨折6例,先固定骨折再修复血管5例,在处理骨折前先建立临时性动脉内分流8例.[结果]所有患者均获随访,随访时间1～7年,平均3.3年.肢体存活17例(81%),截肢4例.截肢者均为入院时肢体严重缺血患者,部分缺血患者无1例截肢;截肢患者中有3例合并严重软组织损伤,l例合并中度软组织损伤;肢体存活患者平均MESS评分4.2±1.3,截肢患者平均7.2±1.8.截肢患者均是由于术后出现难以控制的感染而截肢.[结论]膝部骨折脱位合并胭动脉损伤时,肢体的软组织损伤程度、MESS评分、肢体缺血的严重程度均是影响肢体成活的重要因素,术后感染是造成截肢的主要原因.     

导向环锯减压植骨治疗早中期股骨头坏死

[目的]探讨使用自主设计研发的导向环锯减压植骨治疗早中期（Ficat I、II期）股骨头坏死的手术疗效。[方法]2016年10月—2020年10月，对36例（44髋）早中期股骨头坏死行导向环锯减压植骨术，评价临床和影像结果。[结果]所有患者均顺利完成手术，术中无重要神经血管损伤等严重并发症。手术时间平均（65.2±8.4） min，术中失血量平均（32.5±5.6）ml，术中透视次数平均（20.3±3.6）次，住院时间平均（7.0±1.8）d。所有患者均获随访，随访时间平均（20.8±9.3）个月，术后患肢负重下地时间平均（5.1±0.9）个月。随时间推移，Harris评分[(69.5±5.9)分,(80.2±7.8)分,(82.8±6.6)分, P<0.05]、髋屈-伸ROM [(56.6±7.8)°,(85.5±6.3)°,(91.2±8.2)°, P<0.05]和髋内-外旋ROM [(35.2±5.3)°,(56.5±6.9)°,(62.7±7.2)°, P<0.05]均显著增加。影像方面，2髋在术后1年进展为Ficat 3期，2髋发生股骨头塌陷。[结论]导向环...     

Ilizarov微循环重建技术治疗Wagner 4级糖尿病足临床疗效分析

[目的]总结Ilizarov微循环重建技术对Wagner 4级糖尿病足的治疗效果。[方法]2015年3月~2016年3月,采用Ilizarov微循环重建技术治疗10例Wagner 4级糖尿病足患者。男8例,女2例;左足6例,右足4例;年龄45~82岁,平均(61.8±8.9)岁。均经保守治疗失败,有行截肢指征。术前患足缺血性疼痛强度根据视觉模拟量表,7~10分6例,4~6分4例。术前行CT血管造影证实患肢动脉均存在不同程度的狭窄与闭塞。糖尿病足病程15~102 d,平均(52±6.8)d。[结果]术后10例患足缺血性疼痛均获明显缓解,足部坏疽溃疡创面均愈合,平均治愈时间(72.0±20.5)d,均未截肢。未发生术后胫骨截骨处继发骨折、伤口感染等并发症。10例均获随访,随访时间3个月~1年,平均(6.3±1.2)个月。末次随访时患足缺血性疼痛强度,0分8例,1~3分2例,与术前比较差异有统计学意义(P<0.001)。10例患者均对术后结果感到满意。[结论]Ilizarov微循环重建技术对糖尿病足有较好的临床疗效,术后病情改善明显,可明显降低截肢率,减轻患者痛苦,提高生活质量,是一种值得推广的技术。     

弹性髓内钉治疗儿童前臂骨折的疗效观察

[目的]采用弹性髓内钉作为内固定材料治疗儿童前臂骨折,观察分析其临床治疗效果。[方法] 2015~2019年采用钛制弹性髓内钉固定尺桡骨的方法治疗儿童前臂骨折57例,采用Berton评定标准进行观察评价。[结果]手术时间30~50 min,平均(38.93±4.24) min,术中出血量10~30 ml,平均(17.15±2.86) ml,切口均一期愈合,骨折愈合时间35~60 d,平均(45.11±3.79) d。术中均无神经、血管损伤发生。2例发生皮肤激惹反应,1例出现拇长伸肌断裂。所有患儿均获随访,随访时间3~22个月,平均(17.32±5.69)个月。按照Berton疗效评定标准,优54例,良3例,优良率达100.00%,无骨不连、畸形愈合、切口感染等严重并发症。[结论]弹性髓内钉内固定法治疗儿童前臂骨折安全、可靠,值得推广。     

膝关节多韧带损伤Ⅰ期修复重建

[目的]探讨关节镜下一期修复重建膝关节多韧带损伤的疗效。[方法]2009年4月~2014年12月收治膝关节前交叉韧带(ACL)、后交叉韧带(PCL)损伤及合并内侧副韧带(MCL)Ⅲ度损伤患者39例,男23例,女16例,年龄22~50岁,平均41.4岁。损伤至手术时间10~16 d,平均13 d。所有病例均于早期行关节镜下前、后交叉韧带重建以及内侧副韧带修复。重建材料选择双侧自体腘绳肌腱,内侧副韧带修复采用有限切开缝合或带线锚钉修复。术前、术后采用Lysholm功能评分、IKDC评分及主动关节活动度评估患膝功能。[结果]所有患者均得到随访,随访时间16~30个月,平均20.6个月。末次随访时患者伸膝无明显受限,膝关节屈曲(115±15)°,Lysholm膝关节功能评分为(88.16±5.72)分,关节活动范围为(115±15)°,IKDC评分为(89.25±4.93)分,与术前比较差异均有统计学意义(P0.001)。[结论]关节镜下Ⅰ期修复重建膝关节多韧带损伤安全、有效,治疗效果满意。     

人工踝关节置换的X线评价

[目的]研究人工踝关节置换前后的X线片评价。[方法]提出术前和术后的踝关节正侧位片的X线片评价要点进行分析,根据X线影像确定术前的切骨部位、植骨和固定方法,明确了假体的正确位置和位置异常可能导致的并发症。如踝关节不稳定、半脱位、胫骨基板倾斜、边缘载荷和影像学松动等。[结果]43例随访2年~8年4个月,平均5年5个月。踝关节功能采用Kofoed评价标准和作者评价方法进行分析,优(85~100)32例,良(75~84)9例,差(60~74)2例,无失败(<60)。踝关节功能状况:足背伸6°~16°,跖屈8°~28°,足背伸和跖屈的活动范围14°~38°,平均21.4°。并发症有切口缘皮肤坏死3踝,术中内外踝骨折1踝。无足内翻、足外翻和假体影像学松动病例。[结论]采用正确的X线评价,是提高人工踝关节置换质量,防范和及早发现并发症的重要措施。     

四肢主干血管损伤的诊治

目的探讨四肢主干血管损伤的早期诊断、治疗方法以及临床效果。方法2001年1月-2006年6月，收治72例四肢主干血管损伤患者。男50例，女22例；年龄5～60岁，中位年龄39岁。开放性损伤44例，闭合性损伤28例。动脉损伤部位：锁骨下动脉1例，股动脉23例，胭动脉20例，尺桡动脉同时损伤12例，肱动脉11例，腋动脉3例，胫前后动脉同时损伤2例。伤后至入院时间30min～27d。术中血管破口直接修补3例，端端吻合39例，自体大隐静脉移植修复30例，移植长度3～8cm。结果67例肢体成活，5例截肢。48例获6个月～5年随访，彩色多普勒血流仪检查血流速度及血管口径与健侧无明显差异。40例肢体功能恢复满意，8例残留不同程度功能障碍，其中4例行矫形或功能重建手术，功能及外形得到改善。结论了解损伤机制及受伤情况，认真体检，综合分析，是主干血管损伤早期诊断的关键；显微外科修复是提高血管通畅率的保障；术后筋膜间室综合征及肢体缺血时间超过4h的肱动脉、胭动脉以上的血管损伤，及时行筋膜间室切开是恢复肢体功能、避免伤残的有效手段。     

膝关节闭合骨折合并腘动脉损伤的诊疗体会

[目的]回顾性分析膝关节闭合骨折合并腘动脉损伤的治疗方法和效果.[方法]本组男18例,女3例.车祸伤15例,挤压伤5例,摔伤1例.X线片显示胫骨平台骨折10例,股骨远端骨折7例,二者合并损伤4例.腘部切口探查血管,见膝关节以远损伤8例,膝关节水平损伤6例,膝关节以近损伤7例.动脉挫伤后栓塞18例,破裂3例.术中采用大隐静脉移植修复4例.[结果]全部肢体成活.全部患者获得随访,随访时间12～18个月,平均15个月.骨折完全愈合时间4～6个月,平均5个月,肢端血运良好,足背动脉均可触及搏动.[结论]对于闭合性膝关节周围骨折患者,要高度警惕合并腘动脉损伤.要认真细致和全面检查,早发现,早手术,降低截肢率.     

短期非融合固定治疗枢椎齿状突Ⅱ型骨折后的颈椎活动度

[目的]探讨短期寰枢椎椎弓根螺钉非融合固定治疗枢椎齿状突Ⅱ型骨折后颈椎活动功能。[方法]2012年2月~2017年12月,选取枢椎齿状突II型骨折后接受后路寰枢椎椎弓根螺钉非融合内固定术,并二次手术取出内固定物的患者32例。对比患者自身前后两次手术后颈椎过伸过屈、左右旋转角度,同时参考正常人群颈椎活动度进行比较。[结果]32例患者均顺利完成C1/2椎弓根螺钉非融合内固定术,经影像学确认内固定位置良好,无血管、神经损伤等并发症的发生。于初次内固定术后4~15个月,平均(9.55±2.72)个月,32例患者再次入院行内固定取出术。取内固定术后平均随访(16.41±4.25)个月。末次随访时32例患者前屈、后伸、左旋转和右旋转ROM均显著大于取内固定之前角度(P<0.05),但仍显著不及正常人。[结论]短期寰枢椎椎弓根螺钉非融合内固定治疗枢椎齿状突骨折,可有效保留颈椎活动功能,值得临床推广应用。     

彩色多普勒超声在肢体动脉损伤诊疗中的应用

目的探讨彩色多普勒超声在肢体动脉损伤的诊断和治疗中的临床意义。方法应用彩色多普勒超声检查69例肢体外伤后出现不同程度肢体供血障碍患者,观察损伤处血管及其远、近端血管的二维、彩色血流及多普勒频谱的声像图表现。结果69例中,超声提示血管完全或部分断裂伤13例,手术证实11例;超声提示动脉损伤并血栓18例,手术证实14例;超声提示血管损伤可能19例,手术证实12例;超声提示血管受压、痉挛及或骨室筋膜压力高造成供血障碍19例,临床治疗后全部证实。结论彩色多普勒超声检查是诊断肢体血管损伤和临床治疗后随访观察的最佳手段。     

Management of small artery vascular trauma.

This 11-year retrospective study reviewed 99 arterial injuries distal to the brachial bifurcation or popliteal trifurcation in 89 extremities in 88 patients. Associated injuries occurred in 78 of 88 (89%) patients, including 10 fractures or dislocations, 66 nerve injuries, and 59 single or multiple tendon injuries. Fasciotomy was performed in 9 upper extremities and 11 lower extremities (23% of patients). The selection of operative treatment by arterial repair or ligation was by surgeon choice (52% repair and 48% ligation). Postoperative patency was found in 45 of 47 (96%) repaired arteries. In cases of isolated single arterial injuries (10), there were excellent results, and there was no difference in the results between repair and ligation. In cases of nonisolated single arterial injuries (69), there were 46% and 36% nonvascular complications in the repaired and ligated groups, respectively. In 10 patients with nonisolated multiple arterial injuries in the same extremity, the results of repair of one artery with ligation of the other artery versus repair of both arteries were identical, and there were no vascular complications. Operative exploration was the key to complete evaluation of vascular and neuro/musculoskeletal injuries. The data suggest that one functional artery distal to the elbow or knee is sufficient for limb viability and vascular function (follow-up range: 0 to 110 months; mean: 12 months). Nerve injury was the single most important factor of extremity injury in terms of the degree of functional loss.     

胫腓骨骨折合并下肢主要动脉损伤的诊治

目的 探讨胫腓骨骨折合并下肢主要动脉损伤的诊治,并关注64排CT血管造影(CTA)在其早期诊断中的作用.方法 回顾性分析2000年1月至2008年10月收治的创伤性胫腓骨骨折并怀疑合并下肢主要动脉损伤患者的救治过程,2006年前采用数字减影血管成像术(2例)和彩色多普勒超声(9例)辅助诊断,2006年后采用CTA辅助诊断(7例).一旦确诊,根据不同情况行损伤血管直接吻合、静脉移植或人工血管修复血管,肢体已经坏死者行截肢术.结果 CTA平均检查时间为(42.0±9.5)min,少于数字减影血管成像术的(2.5±0.6)h和彩色多普勒超声的(67±12)min,且准确率高.18例患者中12例得到早期诊断者无肢体功能障碍,6例延迟诊断者5例行部分截肢(趾)手术,1例一期行大腿截肢.结论 早期诊断是胫腓骨骨折合并下肢主要动脉损伤患者救治能否成功的重要因素,CTA在其早期诊断中具有很高的应用价值.     

Humeral shaft fracture with brachial artery injury

The management of ten patients with fracture of the humeral diaphysis and concomitant injury to the brachial artery was analyzed retrospectively for examination of the factors contributing to preservation of limb viability and function. Of ten treated fractures, eight were rigidly stabilized with either a plate or an external fixation device. Seven of the vascular injuries required an interpositional graft. Three arteries were repaired with an end-to-end anastomosis. Two of these repairs failed in patients whose fractures were not rigidly stabilized, and one of these patients required amputation. Fasciotomy was performed in five cases. Seven patients retained normal or functional extremities despite ligation of the brachial artery in two individuals. Preoperative arteriography was of equivocal value, and it doubled the patient's transit time from the emergency room to surgery. The use of a temporary intraluminal vascular shunt to perfuse the limb at surgery and the semi-invasive rigid stability afforded by contemporary external fixators are important advances in the management of these complex injuries. In civilian practice, the prioritized guidelines the authors suggest for care of combined major skeletal and vascular trauma to the arm are: resuscitation of the patient; arteriogram, which is nonessential in open injuries but helpful in closed trauma; intraoperative perfusion of the limb with a temporary shunt; rigid bony stabilization; wound debridement; vascular repair with an autogenous vein graft; neurorrhaphy; and assessment of the need for fasciotomy.     

The utility of physical examination in proximity penetrating extremity trauma.

This study assessed the efficacy of physical examination as a screening modality for the diagnosis of surgically significant arterial injury in proximity penetrating extremity trauma (PPET). All cases of PPET were assessed and admitted per established protocol over a 30-month period from January 1, 1993, to June 30, 1995. No patients were excluded if other body regions were also injured. Landmarks defining upper extremity injuries were the deltopectoral groove to the wrist and for lower extremities from the inguinal ligament to the ankle. Patients admitted with PPET fell into one of three categories: 1) no hard signs of vascular injury present-admitted for 24-hour observation; 2) presence of at least one hard sign of vascular injury-taken immediately to the operating room; 3) positive sign of arterial injury that requires angiography (i.e., diminished but appreciable pulse by physical examination or doppler, large nonexpanding hematoma, bilateral pulse deficit, no appreciable pulse with unreconstructable trajectory). Four hundred six patients with 489 injured extremities secondary to PPET were admitted over a 30-month period. Sixty-two extremities suffered multiple injuries. Of the extremities injured, 83 per cent were secondary to gunshot wounds, 12 per cent were attributed to stabs/lacerations, and 5 per cent were due to shotgun injuries. Four hundred twenty-one extremities with PPET fell into Group 1. There were four missed injuries (specificity, 99%) in this group (one ulnar artery, one radial artery, one posterior tibial artery, and one anterior tibial artery). Two of these injuries were considered surgically significant. None of the patients suffered limb or functional loss as a consequence of their missed arterial injury. Thirty-nine extremities were entered into Group 2, with two patients found to have no arterial injury. Twenty-nine extremities were placed into Group 3 with 10 (35%) found to have surgically significant injury on angiogram. The overall sensitivity and specificity for physical examination was 92 per cent and 95 per cent, respectively, for surgically significant injury. Physical examination is a highly sensitive and specific screening modality for the identification of surgically significant arterial injury in PPET. Patients who present with diminished, but appreciable, pulses by physical examination or doppler, large nonexpanding hematomas as the only sign, bilateral pulse deficits and nonappreciable pulses with unreconstructable trajectory benefit from further investigation with angiography.     

锁骨下动脉损伤的外科处理

目的 探讨锁骨下动脉损伤的外科治疗特点。方法 1990年7月～2006年1月，对12例锁骨下动脉损伤患者，取锁骨上下联合切口，充分显露锁骨下动脉全段，分别采用动脉破口修补、包裹修复、血管吻合及人造血管移植修复重建损伤动脉。均为男性，年龄18～36岁，平均22.6岁。损伤部位：锁骨下动脉第1段1例，第2段4例，第3段7例。损伤类型：均为不完全断裂及破损，其中动脉破损区小于动脉周径1／3者4例，小于动脉周径2／3者5例，大于动脉周径2／3者3例。伴全臂丛神经损伤1例，神经干缺损5cm；部分臂丛神经损伤3例，其中2例仅前束损伤，神经缺损分别为4cm和6cm；正中神经完全损伤及尺神经不完全损伤1例，神经缺损4cm。损伤至手术时间3h～1.5个月。结果 术后无死亡及肢体坏死。获随访2个月～12年，平均5年2个月。10例桡动脉搏动恢复良好，2例桡动脉搏动不明显，均为动脉直接吻合者。4例合并臂丛神经损伤患者，前束损伤者术后肢体功能基本恢复正常，屈肘肌力Ⅳ级；全臂丛神经完全损伤者术后上肢功能基本无改善。结论 锁骨下动脉解剖位置特殊，动脉损伤后显露、修复均较困难。锁骨上下联合切口可在直视下显露动脉全段，修复重建安全可靠。     

Vascular injuries in everyday practice

BACKGROUND: It was the objective of this retrospective study to analyse the causes of injury, surgical approaches, outcome, and complications in patients with vascular trauma and to report our experience with vein homografts for arterial reconstruction in the upper and lower limbs and cervicothoracic region in patients operated on over a period between 1981-2001. PATIENTS: In 128 patients with peripheral arterial injuries the mechanism was direct penetration in 90 cases and blunt injury in 20 cases. In 4 cases a chronic damage (false aneurysm, AV fistula) was observed. Isolated vascular trauma was present in 97 patients (75.8%), 31 cases (24.2%) were aggravated by concomitant bone fractures, and nerve or soft tissue damage. Most frequently injured vessels were the superficial femoral (22.6%), crural (22.6%), and ulnar and radial (13.2%) arteries. 16 patients with penetrating cervicothoracic arterial injuries were registered during this period. 8 patients underwent emergency exploration and 8 patients angiography prior urgent exploration. RESULTS: Saphenous vein interposition grafting was applied with good results in 34 patients, polytetrafluoroethylene and Dacron grafts were used in eight cases, end to end anastomosis in 12 cases, venous bypasses in 5 cases, venous patches in 7 cases. 17 patients underwent arterial repair and 9 venous repair. Vein homografts as an arterial substitute were implanted in 8 patients. Five secondary amputations were performed and five patients died. The limb salvage rate was 95% and the primary patency rate of vein homografts was 75% (excluded primary amputations). The penetrating cervicothoracic injuries were all repaired with improvement in level of consciousness and neurological deficit when present. CONCLUSIONS: Most vascular injuries of the extremities can be managed successfully unless associated with severe concomitant damage of the bones, nerves and soft tissues. In the absence of suitable autologous vein grafts, homografts appear to be an interesting alternative for arterial repair. In penetrating cervicothoracic vascular injuries immediate operative repair offers the best chance of recovery.     

Severe vascular gunshot injuries of the extremities: a ten-year nation-wide analysis from Finland.

BACKGROUND AND AIMS: Gunshot wounds affecting the main vessels of the extremities mostly threaten limb salvage. The purpose of this study was to analyse the nature and severity of civilian vascular gunshot injuries of the extremities using a nation-wide database. MATERIAL AND METHODS: Retrospective analysis of the Finnish Hospital Discharge Register, hospital records and death certificates over a 10-year period from January 1, 1990 to December 31, 1999. RESULTS: Thirty-two individuals with the mean age of 33 years (17-68) sustained 43 severe vascular injuries to the extremities caused by gunshots. The incidence was 6.0 (95% CI: 4.1-8.5) per 10,000,000 person-years and did not change significantly during the period. Four of the injured died. The most common anatomical locations of vascular injuries were the femoral artery (6 lesions), popliteal artery (6) and superficial femoral artery (5). Use of alcohol was detected in ten cases (32% of patients) and of illegal drugs in seven cases (22%). Five patients (18% of non-fatal injuries) required vascular re-operation caused by post-operative problems. Five amputations were performed as primary treatment. CONCLUSIONS: Severe vascular gunshot injuries of the extremities are not common in Finland. The need for primary amputation or vascular re-operations is noteworthy.     

髂股血管创伤29例分析

目的探讨髂股血管损伤的特点及救治方法。方法回顾性分析2002年5月—2006年11月收治的29例髂股动静脉损伤病例的临床资料。29例中,行血管修复27例,其中动静脉联合人工血管移植端端吻合11例,自体大隐静脉移植端端吻合7例,利用自体大隐静脉行血管缺损修补6例,动脉内膜修复取栓并修补2例,血管端端吻合1例。结果本组29例,27例血管修复成功,随访6～12个月,平均随访时间9个月,肢体血液供应良好,深静脉修复的4例长期站立时有下肢不同程度的肿胀。另2例由于肢体已发生坏死或血管床广泛栓塞而截肢。无死亡病例。结论髂股血管损伤发病凶险,早期表现隐匿。仔细的体格检查和彩色多普勒检查有助于尽早发现,而手术探查仍然是最好的诊断方式。早期诊断及尽早恢复肢体血运是救治成功的关键。     

Major Vascular Injuries in the Pediatric Population

Ischemia requiring revascularization is rare in the pediatric population. We have evaluated the immediate and late outcomes for children undergoing peripheral bypass for ischemia secondary to trauma to both upper and lower extremities. Children requiring vascular repair with saphenous vein bypass at a pediatric hospital and trauma center over a 5-year time period were reviewed. Nineteen patients sustained major vascular injuries requiring bypass, with a mean age at time of injury of 13.9 years (5-18). Nine of the 19 patients were available for late follow-up. The mechanism of injury was evenly divided between blunt, 8, and penetrating, 11. Injuries were also relatively evenly distributed between upper, 10, and lower extremities, 9. Associated, nonvascular injuries were present in 79% of patients. There were no deaths, and 95% primary limb salvage was achieved with a multidisciplinary approach. Seventy-five percent of patients were able to resume normal activities after surgery, with a mean time of 1.5 months to full use of the affected limb. The 25% of patients with residual decreased function, despite patent bypasses, had concomitant lower extremity orthopedic injuries. A multidisciplinary approach with orthopedic, hand, and plastic surgery involvement was frequently needed. Good short-term and acceptable long-term outcomes were achieved despite significant limb injuries.