ABSTRACT
PURPOSE: To investigate the arterial rupture, we evaluated the 15 victims of high tension injury. METHOD: The review included clinical course of injured limbs (entrance vs exit), site of spontaneous ruptures (subeschar: G1 vs zone of ischemia: G2), causes (spontaneous vs iatrogenic: G3, inflammatory vs associated thrombi), time and consequences of rupture (site of ligature, vascular manipulation). RESULT: 1) There were 18 spontaneous (G1, G2) and 4 iatrogenic ruptures (G3). 2) The G1 were 8 in 5 patients on the 19.6 +/- 8.1 (6-29)th post burn day: princeps pollicis/dorsalis indicis, dorsalis pollicis/superficial radial, radial, ulnar/radial and posterior tibial artery. The G2 were 10 in 8 patients on the 18.4 +/- 7.2 (9-31)th post burn day: brachial, ulnar, radial, ulnar/radial and branch/trunk of popliteal artery. 3) The G3 were superficial femoral/superficial femoral (at clamping site/anastomosis), subclavian (at clamping site) and princeps pollicis (at ligature) artery by inflammation 2-8 days after surgery. 4) The initial wound of limbs or fasciotomy cannot predict the possible ruptures. 5) The entrance had more ruptures than exit. 6) Five patients had multiple ruptures 1-13 days after first episode (3 at different, 2 at the same limb). 7) There was no difference of rupture time between G1 and G2. The G2 occurred at 2-7 cm apart from burn eschar. 8) Nine among 18 spontaneous ruptures were caused by inflammation. The rest 9 thrombotic ruptures occurred at the arterial wall over (2), at the margin (6) and 2 cm near (1) the thrombi. There was no time difference between inflammatory and thrombotic rupture [19.2 +/- 7.2 (9-31) vs 19.0 +/- 8.0 (6-29) days]. 9) There was no rupture after proximal 2-4 cm ligature at superficial arteries. The thrombi were formed finally in superficial femoral artery at 9 cm proximal to the rupture site. CONCLUSION: We recommend that timely decision to amputate must be made to reduce spontaneous ruptures. Also careful attention should be paid to select the safe distance, at least 10 cm in deep arterial injures, in vascular procedures.