1 Jul 2019Article
Arterial lesions in osteoarticular trauma of the lower limbs
Bilel Derbel 1Daniela Mazzaccaro 2Abdelkader Hfayedh 1Jaleledine Ziadi 1Rim Miri 1Giovanni Nano 3Ghedira Faker 1Raouf Denguir 1
Affiliations
Article Info
1 CardioVascular Surgery Department of La Rabta University Hospital, Tunis
2 First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
3 First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
Ann. Ital. Chir., 2019, 90(4), 364-370;
Published: 1 Jul 2019
Copyright © 2019 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
OBJECTIVE: To evaluate in-hospital mortality and limb salvage of a series of patients presenting with arterial injury of the lower limbs complicating an osteoarticular trauma, and to determine any preoperative predictive factors of limb salvage. METHODS: Data of consecutive patients treated between 01/2007 and 12/2017 were retrospectively analyzed. Primary outcomes were in-hospital mortality and limb salvage. Multivariate analysis was performed to assess any variable that could affect limb salvage. P values <0.05 were considered statistically significant. RESULTS: The postoperative course, death occurred in 2 patients Lower limb amputation was performed in 13 cases (15.6%). The main factors predicting limb amputation were the timing of staged surgery, in particular when bone stabilization was performed first (P<0.001), and a delay Data concerning 74 patients with 83 traumatized lower limbs were analyzed. Most vascular lesions were located at the popliteal artery (47, 63.5%). Surgical bone stabilization was performed as a first step in 45 patients (60.8% of cases), followed by a delayed arterial repair. The median time to revascularization was 14.3 hours (range from 2 hours to 6 days). In 29 patients (39.2%) vascular repair and bone stabilization were performed simultaneously. During to limb revascularization longer than 6 hours (P<0.001). The location of injury at the popliteal artery (P=0.005), the presence of infection (P<0.001), and the severe ischemic signs at presentation (P=0.001) also were factors associated with amputation. CONCLUSIONS: The timing of staged surgical repair and the revascularization delay were the main predictor factors of limb salvage.
Keywords
- Osteoarticular trauma
- Vascular injury
- Limb salvage
- Orthopedic trauma