A Five years audit of surgery for civilian vascular trauma in a teaching hospital.

Abstract

This is a review of 69 consecutive cases of vascular injures managed in a general surgical unit over a period of five years. The object of the review was to study the pattern of injuries, treatment offered and the outcome of these cases. Age of these patients ranged from 16 to 58 years with a male to female ratio of 13: 1. Forty two patients had firearm injury, 17 stab injury and 10 had road side accidents. In 45 cases there was laceration and in 24 cases there was transection of the affected vessels. Thirty eight lacerations were repaired, in ten cases end to end anastomosis was done and in six cases reverse saphenous venous grafting was done. Vascular ligation was only employed when any of the above was not possible. In 14 cases fasciotomy was combined with above procedures or was the only procedure employed. In 75.81% the outcome was successful while in nine cases failure of revascularization resulted in amputation. The complication rate was 36.23% affecting 25 patients (sepsis in 13 renal failure in 3 secondary hemorrhage in 2 and gangrene in 7). There was a mortality rate of 17.39% in this series. Prevention of such injuries, through control of civilian violence and road traffic accidents, remains an ideal. A good ambulance system and properly staffed trauma centers providing a multidisciplinary approach for expeditious limb revascularization, rapid fixation of fractures and adequate soft tissue coverage can lead to an improved outcome.