The Treatment Of Patients With Post-traumatic "Ultra-Time Vascular Injuries" Of The Extremities

Background and objectiveA traumatic major arterial trunk injury can easily lead to limb-threatening ischemia, which can endanger the viability of the extremity and/or the patient’s life.Ischemic time is an important factor that affects limb survival, and physiological and anatomical studies have shown that irreversible muscle cell damage begins after 3 h of ischemia and is nearly complete after 6 h of ischemia. Therefore, it is generally accepted that vascular recanalization should be performed 6-8 h after the arterial injury has occurred. However, a proportion of patient’s with traumatic arterial injuries present after this time, because of delays in their diagnoses and referrals to specialists. The management of these injuries presents a daunting challenge, especially in patients who have associated injuries that are severe, namely, skin and soft tissue injuries, osseous damage, and damage to the neural elementsMethodsIn this study, we conducted a retrospective analysis of 34consecutive patients who presented to the emergency department with traumatic arterial trunk injuries of their extremities more than 8 h after the injuries had occurred. We called these injuries "ultra-time vascular injuries". We determined the demographic characteristics of these patients.A multivariate logistic regression model was used to identify the determinants that were independently associated with limb amputation and disability to provide sound and defensible guidelines for limb salvage.Results1. The age distribution of the high-risk population was from 18 years to 40 years;2. Injuries to the lower limbs (82.4%) were over four times more common than injuries to the upper limbs (17.6%), and open;3. Blunt injuries occurred most commonly (76.5%).4. The overall rate of limb salvage was 82.4%(28/34) and limb function is excellent in 50%(14/28) of the patients.5. The factors that were significantly associated with amputation were nerve injury (P=0.011), complex soft tissue injury (P=0.034), and the occurrence of compartmentsyndrome (P=0.001).6. The factors that were significantly associated with disability included the anatomical location of the injury (P=0.044), a combined arterial and venous (AV) injury (P=0.043), nerve injury (P=0.022), complex soft tissue injury (P=0.002), and the occurrence of compartment syndrome (P=0.002).ConclusionsWe recommend limb-salvage treatment for patients with traumatic ultra-time vascular injuries, particularly for those aged between 18 years and 40 years. While treating the arterial injury, we should pay more attention to nervousl injury and complex soft tissue injury especially the occurrence of compartment syndrome. Furthermore, we encourage the development of limb salvage techniques for ultra-time vascular injuries.