Traumatic Lower Extremity Vascular Injuries and Limb Salvage in a Civilian Urban Trauma Center

Abstract Purpose: A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures.Methods: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice.Results: Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 hours post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. Conclusion: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients’ quality of life.

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Penetrating Popliteal Vascular Injury: Surgical Management and Early Outcome During Current War in Taiz –Yemen

10.21203/rs.3.rs-192242/v1 ◽

2021 ◽

Author(s):

Abudar Abdo AL ganadi ◽

Naseem Saeed Al-Ossabi ◽

Ismail Samer Alshameri ◽

Mamon K Al-Mekhlafi ◽

Maha A Hizam ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Vascular Injury ◽

Graft Infection ◽

Limb Loss ◽

Team Approach ◽

Vascular Injuries ◽

Limb Salvage Rate ◽

Graft Thrombosis ◽

Salvage Rate

Abstract Background: Popliteal vascular injury remains a challenging entity, and carries the greatest risk of limb loss among lower extremity vascular injuries. We aim to review our experience with complex penetrating popliteal vascular injuries, thereby focusing on therapeutic challenges, and early outcomes.Methods: From September 2015 to December 2019, we managed total of 728 penetrating vascular injuries with 163 popliteal vascular injuries presented to Authority of Althawra hospital in Taiz. Of 125 patients, 103 patients were fulfilling the inclusion criteria. Variables were retrospectively collected included patient demographics, mechanism and type of injuries, limb ischemia time, type of vascular reconstruction, associated complications, limb salvage, and mortality.Results: 157 vascular reconstructions were performed for 103 patients with penetrating popliteal vascular injuries, the majority 94 (91.3%) were male. Mean age was 27.3 ± 12.3 years. Popliteal vascular injuries were the second most common accounting for 35% of lower extremity vascular injuries and 22.4% of the total vascular injuries. Nearly half 54 (52.4%) of patients sustained complex popliteal vascular injuries (arterial and venous injuries), 31 (30.1%) isolated arterial injuries, and 18 (17.5%) isolated venous injuries. Management of vascular injury was repaired by interposition graft in 68 (66%), end-to-end anastomosis in 16 (15.5%), and venous patch in 1(1%). Venous injury was repaired in 53 (51.4%) and ligated in 18 (17.5%). Less than 6 hours from injury to completed revascularization was achieved in 58 (56.3%) patients. The overall fasciotomy was 28 (27.2%) which significantly increased length of hospital stays (17 days vs 7 days, P= 0.0003). The overall limb-salvage rate in our study was 94.2%. During the study period, the most common complication was 14 (13.6%) wound infection, 14 (13.6%) graft thrombosis, 6 (5.8%) bleeding, 4 (3.9%) graft infection. Early limb loss occurred in 6 (5.8%) and the mortality rate was (1.9%).Conclusions: Wartime penetrating popliteal vascular injury is a real challenge. However, team approach and promptly vascular repair found to associate with a remarkable limb salvage rate of 94.2%. We advocate repair of arterial injury with vein graft as the treatment of choice whenever possible.

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A Leg to Stand On: Trauma Center Designation and Association with Rate of Limb Salvage in Patients Suffering Severe Lower Extremity Injury

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.04.012 ◽

2021 ◽

Author(s):

Corinne Bunn ◽

Sujay Kulshrestha ◽

Bianca DiChiaro ◽

Uma Maduekwe ◽

Zaid M. Abdelsattar ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Trauma Center ◽

Lower Extremity Injury ◽

Extremity Injury

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Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v1i1.6 ◽

2017 ◽

Vol 1 (1) ◽

pp. 22-27

Author(s):

Edwin R Faulconer ◽

Rachel M Russo ◽

Anders J Davidson ◽

Meryl A Simon ◽

Erik S DeSoucy ◽

...

Keyword(s):

Lower Extremity ◽

Open Surgery ◽

Management Strategies ◽

Balloon Occlusion ◽

Vascular Injuries ◽

Endovascular Management ◽

Review Of The Literature ◽

Junctional Zone ◽

Endovascular Interventions ◽

Direct Pressure

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

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Ipsilateral rotational double‐barrel fibula autograft for limb salvage in a pediatric patient with lower extremity intramedullary osteosarcoma: A case report

Microsurgery ◽

10.1002/micr.30487 ◽

2020 ◽

Vol 40 (2) ◽

pp. 247-251

Author(s):

Brandon Barnds ◽

Ariel Johnson ◽

Howard Rosenthal ◽

Michael Tilley

Keyword(s):

Case Report ◽

Lower Extremity ◽

Limb Salvage ◽

Pediatric Patient

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Impact of Interdisciplinary System-Wide Limb Salvage Advisory Council on Lower Extremity Major Amputation

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.121.011306 ◽

2021 ◽

Author(s):

Mehdi H. Shishehbor ◽

Tarek A. Hammad ◽

Tonia J. Rhone ◽

Ahmad Younes ◽

Norman Kumins ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Major Amputation ◽

Advisory Council

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Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1667363 ◽

2018 ◽

Vol 35 (02) ◽

pp. 117-123 ◽

Cited By ~ 7

Author(s):

Jocelyn Lu ◽

Michael DeFazio ◽

Chrisovalantis Lakhiani ◽

Michel Abboud ◽

Morgan Penzler ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Diabetic Foot ◽

Functional Outcomes ◽

Free Tissue Transfer ◽

Major Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Flap Survival ◽

Foot Reconstruction

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery. Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations. Conclusion FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.

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