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VASCUALR INJURY OF THE EXTREMITIES. DR SIKHOSANA. Subclavian artery. Axillary artery. Injuries. • Most due to penetrating trauma • In 20% both the vein and the artery are injured • 5-14% of the 1 st rib fracture are associated with the vascular injury. Surgical repair.
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VASCUALR INJURY OF THE EXTREMITIES DR SIKHOSANA
Injuries • Most due to penetrating trauma • In 20% both the vein and the artery are injured • 5-14% of the 1strib fracture are associated with the vascular injury
Surgical repair • 1stpart of the R subclavian –sternotomy and supraclavicular and the L- 3rdintercostal thoracotomy • 2ndand 3rdsubclavian and 1stpart axillary- supraclavicular and infraclavicular incision • 2ndand 3rdaxillary deltopectoral groove • All should be repaired • BRACHIAL PLEXUS INJURY !!!!!!!!
Significance • 0-8% amputation rate - in relation to the profunda brachial • Commonly due to penetrating trauma • Major morbidity due to nerve injury
Surgical repair • Position -supine, abduction and external rotation • Incision- bicipital groove • MEDIAN NERVE !!!!!!!
Surgical repair • Repair if both are injured - larger ulnar - superficial radial • Interrupted sutures • Compartment syndrome less common compared to the lower limb
Significance • One of the commonly injured vessels • Amputation rate following repair- 6.25% • Ligation - 50% amputation rate
Femoral incisions • Femoral triangle – midpoint of symphysis pubis and the anterior iliac spine • Adductor canal – lateral border of the sartorius muscle
Significance • Most limb threatening vascular injury - tenuous collaterals - worse with blunt trauma and high velocity gunshot • In WW II primary ligation resulted in 72.5% amputation
Surgical repair • Position- supine, support under the knee, hip externally rotated • Incision- ideal for trauma = medial approach
Crural vessels • Controversial – about when to repair • Problems- they are small - not easily assessable • Low chances of injuring all the three vessels