Comprehensive analysis of the ischemic times of main artery injury in the limbs / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To study the ischemic times of the main artery injury in the limbs and the influence on the limbs survival rate, and to analyze the reasons for the formation of the ischemia time.</p><p><b>METHODS</b>From June 1996 to November 2012, 83 patients with completely severed limb main artery treated in our hospital were retrospectively studied. There were 77 males and 6 females, including 81 adults (ranging in age from 16 to 52 years old, with a median age of 35 years old) and 2 children (4 and 5 years old respectively). Seventy-five patients were treated with end to end anastomosis, 7 patients were treated with great saphenous vein transplantation, and 1 patient was treated with artificial blood vessel transplantation. The prior to admission ischemia time, after admission ischemia time and total ischemia time for successful and unsuccessful patients, as well as the causes of the formation of the ischemia time were studied. Limb survival rate of different ischemic time was counted. Sharpness injury or blunt injury ischemia time and amputation rate were researched statistically. All data were analyzed using SPSS statistical software.</p><p><b>RESULTS</b>There were 72 limbs survived, 11 amputated. The average ischemia time was (7.45±5.94) h for limb-salvage group and (13.73±14.00) h for amputation group. Prior to admission ischemia time between amputation and limb-salvage group had no significant difference. After admission the ischemia time in amputation group was longer than limb-salvage group. The amputation rate for ischemia time 21 to 44 h group was higher than other three groups (≤ 5 h, 6 to 10 h, 11 to 20 h) (P=0.023, 0.038, 0.044). Amputation reasons can be divided into anastomosis failure in the operation, vascular thrombosis 2 to 4 days after operation and late infection.</p><p><b>CONCLUSION</b>Vascular injury limbs can tolerate longer ischemia time and the limb salvage succeed. Only too long ischemia time (> 20 h), limb amputation rate increases significantly. The main cause of long time ischemia is delayed diagnosis in the hospital. Whether limb-salvage success mainly depends on the degree of trauma and the quality of the anastomosis than ischemia time.</p>