WAR INJURIES OF THE CRURAL ARTERIES

Twenty-eight patients with military crural vascular injuries are prese nted. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 m in). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3-47 (mean 14) days. Hyperbaric oxygena tion therapy was used in conjunction with surgery and antibiotic thera py in 13 of the 28 patients. Explosive injuries were found in 14 patie nts and high-velocity missile injuries in nine; associated fractures w ere present in 20. Twenty of the 28 patients with crural vascular inju ries had combined arterial and venous injuries, while eight had isolat ed arterial injuries. Twenty-five patients with distal ischaemia requi red arterial repair; five late amputations resulted. Military crural v ascular injuries should be treated with soft tissue debridement, remov al of foreign material, and microvascular arterial and concomitant vei n reconstruction. This should be followed by external skeletal stabili zation for bony and/or soft tissue instability, with fasciotomy for an y associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric o xygen therapy reduced the amputation rate following combat-related cru ral vessel injuries.