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VASCUALR INJURY OF THE EXTREMITIES

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

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  1. VASCUALR INJURY OF THE EXTREMITIES DR SIKHOSANA

  2. Subclavian artery

  3. Axillary artery

  4. 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

  5. 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 !!!!!!!!

  6. Relation to the plexus

  7. Brachial artery

  8. Significance • 0-8% amputation rate - in relation to the profunda brachial • Commonly due to penetrating trauma • Major morbidity due to nerve injury

  9. Surgical repair • Position -supine, abduction and external rotation • Incision- bicipital groove • MEDIAN NERVE !!!!!!!

  10. Radial and ulnar arteries

  11. Surgical repair • Repair if both are injured - larger ulnar - superficial radial • Interrupted sutures • Compartment syndrome less common compared to the lower limb

  12. Femoral artery

  13. Significance • One of the commonly injured vessels • Amputation rate following repair- 6.25% • Ligation - 50% amputation rate

  14. Femoral incisions • Femoral triangle – midpoint of symphysis pubis and the anterior iliac spine • Adductor canal – lateral border of the sartorius muscle

  15. Popliteal artery

  16. 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

  17. Surgical repair • Position- supine, support under the knee, hip externally rotated • Incision- ideal for trauma = medial approach

  18. Crural vessels • Controversial – about when to repair • Problems- they are small - not easily assessable • Low chances of injuring all the three vessels

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