Peripheral Vascular Trauma

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Types of Injuries

Penetrating Trauma

  • Mechanasim
  • Stab Wound
  • Low velocity bullet wounds

Blunt Trauma

  • Mechanasim
  • Motor vehicle accidents
  • Falls from Heights

These injuries may or may not be associated with bony fractures

 

Initial Assessment & Resuscitation

  1. Airway, Breathing, Circulation
  2. Rule out other life threatening injuries
  3. Two I/V lines with branula no 16, start Ringers lactate.
  4. Send blood for crossmatch and baseline investigation.  Arrange blood.
  5. Inj. Ampiclox 500 mg I/V ATD.
  6. Tetanus Prophylaxis.
  7. Inj. diclofenac sodium 75 mg I/M
  8. If external bleeding Control of bleeding by
  • Pressure bandage.
  • Packing.
  • Elevation.
  • Manual compression
  • Don’t use tourniquet and blind clamping of the vessel.
  • If circular dressing or POP cast has been applied, assess for constriction. Release them if there is any suspicion of it being too tight.

The aim of management is to identify vascular injury before clinical ischemia develops.

 

Physical Examination

Hard signs

  • Pulse deficit
  • Pulsetile bleeding à Arterial injury
  • Oozing and streaming à venous injury
  • Thrill
  • Bruit
  • Expanding hematoma

Treatment  immediate surgical exploration

Soft signs

  • Diminished but palpable pulse
  • Non expanding hematoma
  • Nerve deficit
  • Significant soft tissue injury

 

 

Treatment: Needs further investigation and serial observation by following investigations:

  • Doppler USG
  • Angiography

Investigations

  • Obvious injury needs no investigation, only baseline investigation for anaesthesia. Exploration within 4—6 hours (muscles and nerves tolerate anoxia for six hours)
  • Insidious
  • Conventional Angiography in case of closed injury.
  • Plain x-ray in case of suspected bone fracture

Treatment:

–   Control of haemorrhage

–    Restoration of Blood loss

–    Call to Orthopaedic department in case of associated fracture of bone

–    Mobilization of the injured vessel 5000 units I/V Heparin before clamping the vessel. Proximal and distal control of the vessel.

Operative Treatment

–    Depends on degree of arterial damage

–    Primary repair for small defects without compromising vascular lumen

–    Placement of Graft for large defects

–    Fasciotomy distal to vascular reconstruction to free swollen ischaemic muscle compressed within fascial compartments always be performed.

POSTOPERATIVELY

  • Inj. Ampicillin 500 mg I/V 6 hourly.
  • Inj. Diclofenac sodium 75 mg I/G 8 hourly.
  • Inj. Heparin 800 units per hour
  • Infusion in case of vein repair. (Monitor APTT)