Journal of Medical & Surgical Pathology
Open Access
ISSN: 2472-4971
ISSN: 2472-4971
Sobhi Mleyhi
Tunisia
Posters & Accepted Abstracts: J Med Surg Pathol
Background: Gunshot wounds affecting the vessels of the extremities are rarely encountered in civilian trauma. The resulting lesions are often complex involving soft-tissue, bone, vascular, musculotendinous and nerve injuries which might threaten limb salvage and patient’s life, thus they justify a rapid and efficient management in a specialized center. Beside this challenge, ballistic trauma presents the problem of forensic assessment of gunshot injuries. The purpose of this study is to describe the medico-surgical treatment of ballistic limb trauma with vascular damage and elaborate strategies for managing and surgically treating complex associated lesions.
Methods: We retrospectively reviewed 12 patients who underwent surgery for injuries caused by firearms in the extremities associated with vascular lesions during the period from January 13, 2011 to August 24, 2011 in the department of cardiovascular surgery, Rabta hospital.
Results: This study included 12 males, the mean age was 33 years. Five patients (41.7%) appeared in hemodynamic shock. Eleven patients (91.7%) with extremity injury presented with ischemic signs, six (50%) had arterial bleeding and 1 patient was seen at the stage of aneurysmal complication. The site of lesions was the lower limb in 10 cases (83.5%) and the upper limb in 2 cases (16.5%). Fourteen arterial lesions were observed, the superficial femoral artery and the popliteal artery were the most affected (28.6%). Eight patients (66.7%) had venous lesions, 4 patients (33.4%) had bone and nerve lesions. All patients underwent an arterial repair (10 vein grafts, 1 end to end anastomosis and 1 direct suture). All bone lesions were treated by either internal or external methods of skeletal stabilization. Two deaths were recorded (16.7%): the first patient died during surgery in a hemorrhagic shock, the second in a septic shock in the ninth postoperative day. Morbidity rate was 33.3%. Three patients (25%) had an infection, one patient (8.4%) presented a graft thrombosis. Mean follow-up was 18 months and no complications were observed in the long term.
Conclusion: The management of vascular injuries of the extremity caused by firearms requires fast and effective resuscitation and meticulous surgical treatment by a multidisciplinary team. Outcomes are dependent upon associated trauma. In fact, isolated vascular injuries have a better prognosis in the medium and long term. The postoperative morbidity and mortality are directly related to the hemodynamic status at admission, time interval between trauma and the vascular repair and successful intervention that should be carried out promptly by experienced surgeons in an adequately equipped environment.