ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 129-133

Management of lower limb vascular injuries in a tertiary care centre: An Indian scenario


Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Correspondence Address:
Devika Rakesh
Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_72_20

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Context: Lower limb vascular trauma accounts for majority of peripheral vascular injuries. Delay in diagnosis and referral to higher centers in developing countries like India poses a major challenge with regard to optimum management of these vascular injuries. Aims: The aim was to study the time gap between injury and revascularization and the incidence of reperfusion injuries in patients presenting late to the hospital. Materials and Methods: This descriptive prospective study involved 51 patients who presented with clinical signs of vascular injury confirmed by handheld Doppler. In cases presenting late (more than 6 h), decision to proceed with revascularization versus primary amputation was based on distal muscle viability tested intraoperatively. All anastomosis were done under microscopic magnification with the use of venous graft wherever needed. Results: All 51 patients in the study were males with a mean age group of 32.6 years. Six patients underwent primary amputation. Road traffic accidents were the most common cause of injury with popliteal artery involvement in most cases. Of the total 45 patients who underwent revascularization, 25 patients (55.5%) presented within the golden period of 6 h and only five patients (11.1%) underwent revascularization within 6 h of injury despite which we had a limb salvage rate of 88.8%. Reperfusion injury was seen in 14 patients, vascular thrombosis in three patients and two deaths were reported. Conclusions: We thus recommend that decision to reperfuse the involved limb should not be solely based on the time elapsed but also on factors such as muscle viability and neurological status, especially in a country like India.


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