Scribd Logo
Hochladen

Willkommen bei Scribd!

  • Vascular Trauma: W. Binafsihi

    Hochgeladen von

    ony
    43 Ansichten33 Seiten
    Combined vascular-skeletal trauma 0.2% of all trauma 10%-15% blunt limb vascular trauma 0.3%-3% limb arterial injury of all FXs 10%-70% amputation rate howe, Am Surg 1987;53-205 vascular trauma PROGNOSTIC FACTORS FOR LIMB SALVAGE time mechanism anatomic location associated injuries physiologic health clinical presentation SEQUENCE history clinical noninvasive intraop invasive postop vascular trauma posterior knee dislocation 30%-60% popliteal arterial injury vascular trauma

    Originalbeschreibung:

    Originaltitel

    Vascular Trauma

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Verfügbare Formate

    PDF, TXT oder online auf Scribd lesen

    Stufen Sie dieses Dokument als nützlich ein?

    Sind diese Inhalte unangemessen?

    Dieses Dokument melden
    Combined vascular-skeletal trauma 0.2% of all trauma 10%-15% blunt limb vascular trauma 0.3%-3% limb arterial injury of all FXs 10%-70% amputation rate howe, Am Surg 1987;53-205 vascular trauma PROGNOSTIC FACTORS FOR LIMB SALVAGE time mechanism anatomic location associated injuries physiologic health clinical presentation SEQUENCE history clinical noninvasive intraop invasive postop vascular trauma posterior knee dislocation 30%-60% popliteal arterial injury vascular trauma

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Als PDF, TXT herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    43 Ansichten33 Seiten

    Vascular Trauma: W. Binafsihi

    Hochgeladen von

    ony
    Combined vascular-skeletal trauma 0.2% of all trauma 10%-15% blunt limb vascular trauma 0.3%-3% limb arterial injury of all FXs 10%-70% amputation rate howe, Am Surg 1987;53-205 vascular trauma PROGNOSTIC FACTORS FOR LIMB SALVAGE time mechanism anatomic location associated injuries physiologic health clinical presentation SEQUENCE history clinical noninvasive intraop invasive postop vascular trauma posterior knee dislocation 30%-60% popliteal arterial injury vascular trauma

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Als PDF, TXT herunterladen oder online auf Scribd lesen
    Markieren Sie unangemessene Inhalte
    von 33

    VASCULAR TRAUMA

    W. Binafsihi
    RSPAD
    Gatot Soebroto
    Jakarta
    combined
    vascular-skeletal
    trauma
    0.2% of all trauma
    10%-15% blunt limb vascular trauma
    0.3%-3% limb arterial injury of all FXs
    10%-70% amputation rate

    Howe, Am Surg 1987;53-205


    Attebery, J A C S 1996;183:377
    89MF/10yrs rural 10.000sqmiles

    Traffic 33% 34% arteriography


    13 1 oamputations
    Farm/Industrial 16%
    6 2 oamputations
    Gun, knives etc 51%
    Kolvunen D
    Nichols K
    12.4% complication
    Silver D 5.6% mortality
    University of Missouri
    Health Sciences Center
    U.S.A.

    Surgery 1982; 91(6):723-727


    vascular trauma
    PROGNOSTIC FACTORS FOR LIMB SALVAGE

    time
    mechanism
    anatomic location
    associated injuries
    physiologic health
    clinical presentation
    SEQUENCE

    history
    clinical
    noninvasive
    intraop invasive
    postop invasive
    vascular trauma
    MOLECULAR BIOLOGIC MILLEU
    free radicals
    neutrophils
    degraded arachidonic acids
    RENAL
    LIVER
    CARDIAC
    LUNGS
    posterior knee dislocation

    30%-60% popliteal arterial injury

    20%-50% amputation rate

    Frykberg, Surg Clin N A 2002;82:67-89


    vascular trauma
    SOFT SIGNS

    NEUROLOGIC deficit
    LIMITED hematoma
    HISTORY OF hemorrhage
    CONTRALATERAL strong pulses
    vascular trauma
    HARD SIGNS
    ABSENT pulses
    BRUIT/thrill
    PULSATILE hematoma
    ACTIVE hemorrhage
    DISTAL ischaemia pain
    pallor
    paralysis
    paraesthesia
    poikilothermia
    vascular trauma
    MANAGEMENT PRIORITIES
    life threathening associated injuries
    extremity reperfusion
    skeletal stabilization
    soft tissue: debridement
    hemostasis
    nerve & tendon
    irrigation
    wound coverage
    skeletal-vascular trauma
    RATIONALE PRIORITIES
    perfusion is sine qua non
    minimizes delay to maximize salvage
    mostly negligible incidence
    (of initial vascular disruption)

    LIMB SURVIVAL/FUNCTIONS
    combined vascular-skeletal trauma

    19 amputations skeletal 60%


    vascular 9%

    35 amputations skeletal 36.5%


    vascular 16.6%
    J Trauma 1983;23:279
    J Cardiovasc Surg 1979;20:473
    combined vascular-skeletal trauma

    interval to revascularization
    skeletal 273 minutes
    vascular 137 minutes

    J Trauma 2003;54:211
    combined efforts
    REPERFUSION CONSIDERATONS
    exposure for proximal and distal control
    vessel debridement
    distal thrombectomy
    distal heparin flush
    RESTORE FUNCTION intraluminary shunt
    vascular repair
    FASCIOTOMY
    completion arteriography
    full thickness tissue coverage
    Ruptur a.Femoralis Superfisial I
    Repair & Graft
    Pasca--repair & graft
    Pasca
    Infeksi pasca iskemia
    Thomas J. Fogarty

    1963

    Das könnte Ihnen auch gefallen