Document Detail

An algorithmic approach to the management of limb ischemia in infants and young children.
MedLine Citation:
PMID:  23142939     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Vascular injuries in newborns are rare and most commonly occur in the process of obtaining vascular access for monitoring organ system functions or interventions in critical care. Care of vascular injuries in neonates poses several challenges, with the most significant arguably being the lack of clinical experience with such injuries. An algorithm for the management of arterial injuries in pediatric patients is investigated and reported.
METHODS: A retrospective chart analysis was performed on all patients consulted for the management of vascular injury by the plastic surgery service at Texas Children's Hospital between 1997 and 2005. The outcomes and procedures were reviewed.
RESULTS: Thirty vascular insults in 28 patients were evaluated and treated by the senior author (J.D.F.) using this protocol. Thirty-seven percent (11 of 30) were approached surgically, including two cases treated with thrombolysis alone. The remaining 63 percent (19 of 30) were managed with more conservative interventions, including anticoagulation and clinical optimization. When color Doppler imaging was used preoperatively to locate and describe the characteristics of vascular injuries, visualized lesions coincided with the surgical findings in 100 percent (11 of 11 cases). Twenty-three limbs (77 percent) were salvaged completely using this algorithm, one was initially salvaged but later developed limb-length discrepancy requiring amputation, and one experienced complete limb loss. The remaining patients (five of 30) died as a result of complications of their primary medical conditions before limb salvage could be assessed.
CONCLUSION: This evaluation demonstrates the efficacy of the proposed algorithm used to determine direction of care in the event of arterial injury in small children.
Cara Downey; Oluseyi Aliu; Stephanie Nemir; Bindi Naik-Mathuria; Daniel A Hatef; Jamal M Bullocks; Jeffrey D Friedman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-01     Completed Date:  2013-04-22     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  573-81     Citation Subset:  AIM; IM    
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MeSH Terms
Arteries / injuries*,  surgery*
Child, Preschool
Extremities / blood supply*,  injuries,  surgery*
Infant, Newborn
Ischemia / etiology*,  therapy*
Limb Salvage / methods*
Retrospective Studies
Wounds and Injuries / complications,  therapy
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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