A two-year experience of treating vascular trauma in the extremities in a military hospital.

OBJECTIVE: To assess the presentation, diagnostic evaluation, various techniques of vascular repair and their outcomes.

METHODS: The prospective descriptive study was conducted at the Combined Military Hospital, Rawalpindi, from October 2008 to December 2010. It involved 54 patients with vascular injuries in the extremities who underwent various vascular surgical interventions.Those who presented with irreversible ischaemia or had primary amputation and presented late with missed vascular injuries were excluded. The cases were evaluated for mechanism of injury, site and type of injury, associated injuries, type of repair performed and its outcome. Mean with standard deviation and frequency and percentage was calculated wherever relevant.

RESULTS: The mean age of 54 patients was 26.8 +/- 9.2 years (range: 9-67 years), and the male-to-female ratio was 17:1. Penetrating trauma was the most common cause (n=34; 62.9%). Lower extremities were affected more commonly (n=33; 61.1%) and superficial femoral artery was the most frequently involved vessel (n=14; 25.9%). Besides, 16 (29.6%) patients had associated fractures, while concomitant venous injuries were present in 12 (22.2%). Interposition autogenous saphenous vein graft was the most common type of repair performed (n=42; 77.7%). Prosthetic graft was used only in 3 (5.5%) patients. Wound infection was the common complication (n=6; 11.1%). Three (5.5%) patients had secondary amputation and 2 (3.7%) died due to associated injuries. Vascular reconstruction was successful in 49 (90.7%) cases.

CONCLUSION: Early recognition and re-vascularisation by a vascular surgeon hold the key to saving more than 90% limbs with vascular injuries.