RESULTS OF RECONSTRUCTION IN MAJOR PELVIC AND EXTREMITY VENOUS INJURIES

Purpose: Outcome and venous patency after reconstruction in major pelv ic and extremity venous injuries was studied. Methods: We retrospectiv ely reviewed 46 patients with 47 venous injuries. Results: Injuries we re caused by penetrating trauma in 37 extremities, blunt trauma in 6 p atients, and were iatrogenic in 4 patients. Pelvic veins were injured in 4 patients, low-extremity veins were injured in 39 limbs in 38 pati ents, and upper-extremity veins were injured in 4 patients. Concomitan t arterial injuries occurred in 37 patients. Venous repairs were mostl y of the complex type and included spiral or panel grafts in 15 (32%) reconstructions, interposition grafts or patch venoplasty in 19 (40%) reconstructions, end-to-end and lateral repair in 11 patients, and lig ation in 2 patients. Two patients underwent early amputation. Early tr ansient limb edema occurred in 2 patients, and postoperative venous oc clusions were documented in 4 patients. full function was regained in 39 (81%) extremities. No variable, including 4 retrospectively applied extremity injury scores (mangled extremity severity score [MESS] Limb salvage index [LSI], mangled extremity syndrome index [MESI], predict ive salvage index [PSI]), correlated with outcome. High values on all 4 scores were significantly associated with reexplorations (P < .02), which were done in 8 patients for debridement (5), arrest of bleeding (2), and repair of a missed arterial injury (1). Follow-up of 28 +/- 6 months on 27 patients (57%; duplex scan in 18, continuous-wave Dopple r and plethysmography in 9, and venography in 3) showed 1 occlusion 6 weeks after the injury and patency of all other venous reconstructions . Conclusion: Reconstructions of major venous injuries with a high rat e of complex repairs result in a large proportion of fully functional limbs and a high patency rate. A high extremity injury score predicts the need for reexploration of the extremity. Most occlusions occur wit hin weeks of injury, and the subsequent delayed occlusion rate is very low.