Document Detail


The Belfast approach to managing complex lower limb vascular injuries.
MedLine Citation:
PMID:  16618547     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Complex lower limb vascular injuries (CLVIs) in high-energy penetrating or blunt trauma are associated with an unacceptably high incidence of complications including amputation. Traumatic ischaemia and ischaemia-reperfusion injury (IRI) of skeletal muscle often lead to limb loss, the systemic inflammatory response syndrome (SIRS) which affects remote organs and even the potentially fatal multiple organ dysfunction syndrome (MODS). Surgical care of CLVIs everywhere, including Northern Ireland until 1978, was governed by an anxiety to restore arterial flow quickly often using expedient and flawed repair techniques while a damaged major vein was frequently ligated. MATERIALS AND METHODS: A new policy centred on early intraluminal shunting of both artery and vein, restoring arterial inflow and venous outflow, respectively, was introduced at the Regional Vascular Surgery Unit of The Royal Victoria Hospital, Belfast in 1979. It imposed a disciplined one-stage comprehensive approach to treatment involving a sequence of operative manoeuvres in which all damaged anatomical elements receive meticulous and optimal attention unshackled by time constraints. RESULTS: Comparisons drawn between the pre-shunt period of unplanned treatment (1969-1978) and the post-shunt period centred on the use of shunts (1979-2000) showed that early shunting of both artery and vein in both penetrating (P) and blunt (B) injuries significantly reduced the necessity for fasciotomy (P: p=0.016, B: p=0.02) and caused a significant fall in the incidence of contracture (P: p=0.018, B: p=0.02) and of amputation (P: p=0.009, P: p=0.012). CONCLUSIONS: The policy of early shunting of artery and vein in CLVIs has proved to be of great benefit in terms of significantly improved outcomes, better operative discipline and harmonious collaboration among the specialists involved.
Authors:
A A B Barros D'Sa; D W Harkin; P H B Blair; J M Hood; E McIlrath
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Publication Detail:
Type:  Journal Article     Date:  2006-04-18
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  32     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-08-18     Completed Date:  2006-10-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  246-56     Citation Subset:  IM    
Affiliation:
Regional Vascular Surgery Unit, The Royal Victoria Hospital, Belfast, UK. aires.barrosdsa@btinternet.com
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MeSH Terms
Descriptor/Qualifier:
Blood Vessels / injuries*
Fascia / surgery
Humans
Leg Injuries / physiopathology,  surgery*
Popliteal Artery / injuries
Reconstructive Surgical Procedures
Reperfusion Injury / prevention & control
Vascular Patency
Vascular Surgical Procedures*
Wounds, Penetrating / surgery*

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


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