Penetrating peripheral vascular injury management in a Sri Lankan military hospital
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ORIGINAL ARTICLE
Penetrating peripheral vascular injury management in a Sri Lankan military hospital A. Ratnayake • B. Samarasinghe • K. Halpage M. Bala
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Received: 1 May 2012 / Accepted: 6 September 2012 / Published online: 25 September 2012 Ó Springer-Verlag 2012
Abstract Purpose Vascular injuries in austere military conflict settings are a challenging problem. The goal of the current study was to analyze the unique features associated with the management and early outcome of penetrating vascular injuries resulting from the conflict in Sri Lanka. Methods All adults with extremity vascular injuries admitted to the Military Base Hospital Anuradhapura in an eight-month period were prospectively recorded in a data sheet and retrospectively analyzed. Mechanism, location, method of repair, and outcomes were analyzed. Result Out of a total of 5,821 combat-related casualties, there were 128 victims with vascular injuries (2.2 %). The overall limb salvage rate was 83 % with an all-cause mortality of 3.1 %. Combined arterial and venous injuries were most common (44 %), predominantly in the popliteal zone. Among the arterial injuries, 70 % were repaired with a vein interposition graft and 7 % were primarily repaired. The majority of the venous injuries (54 %) were ligated. Twenty early major complications were recorded. A temporary intraluminal shunting technique was applied in the 14 most severely injured patients. This patient population was followed up for an average of 35 days institutionally
A. Ratnayake K. Halpage Military Base Hospital, Anuradhapura, Sri Lanka B. Samarasinghe Department of Surgery, University of Peradeniya, Peradeniya, Sri Lanka M. Bala (&) Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Kiriat Hadassah, POB 12000, 91120 Jerusalem, Israel e-mail: [email protected]
before they were referred to rehabilitation (60 %) or transferred to other institutions (26 %). Conclusions Vascular reconstruction using vein, combined with a wound management strategy and early fasciotomy, resulted in a high limb salvage rate and remarkably low infection, delayed amputation, and mortality rates. Management of combat vascular injuries based on clinical guidance is feasible and leads to good outcome in a minimally equipped setting during local military conflicts. Surgeons in military hospitals should be trained in vascular injury repair to save the lives and functional limbs of patients. Keywords Vascular injuries Combat experience Military hospital Limb salvage Early fasciotomy
Introduction Combat vascular injuries often combine massive soft-tissue destruction with osseous and neurological trauma [1, 2]. Further complicating the situation, the surgeon has to serve in a setting that is far from ideal and lacks valuable resources [3]. In current conflicts, surgeons generally attempt limb salvage unless the extremity is so badly mangled that salvage is pointless or orthopedic reconstruction is unavailable, based on the degree of soft-tissue and nerve damage and ext
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