RESULTS OF RECONSTRUCTION IN MAJOR PELVIC AND EXTREMITY VENOUS INJURIES

Citation
G. Zamir et al., RESULTS OF RECONSTRUCTION IN MAJOR PELVIC AND EXTREMITY VENOUS INJURIES, Journal of vascular surgery, 28(5), 1998, pp. 901-908
Citations number
29
Categorie Soggetti
Surgery,"Peripheal Vascular Diseas
Journal title
ISSN journal
07415214
Volume
28
Issue
5
Year of publication
1998
Pages
901 - 908
Database
ISI
SICI code
0741-5214(1998)28:5<901:RORIMP>2.0.ZU;2-G
Abstract
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.