In order to develope a new method to overcome the difficulties in anastomosis of blood vessels with different diameter, phleboplasty was utilized at the join-point to expand the diameter of branched vein graft, with a funnel-shaped stoma formed consequently. After successfully experimented in fresh blood vessels in vitro, the method was practised clinically to repair injured arteries in extremities, with the outcome that phleboplasty of branched vein graft could enlarge the diameter by 1-1.25 times, and with satisfied effects in 3 clinic cases. So, the conclusion was that: phleboplasty of branched vein graft was a new effective and convinient method to repair injured arteries with different diameters
Seventy-four cases of peripheral arterial injuries in recent 30 years were reported. Mostof them were main arteies in extremeties. Twenty-eight cases were performed end to end anastomosis and 7 of them received amputation for various complications. We also performed 12 cases of reparatidn of wall, 20 cases of vascular grafts and 7 cases of arterial ligation. There were 16 cases of amputation and one death. We think that artemal injuries should be operated as soon as possible. Arteial reconstruction was mostly used, including reparation of wall, end-to-end anastomosis and autovenous graft. Other procedures should be emphasized, such as complete debridement of the soft tissue and vessels, appropriate fixation of fracture, exploration and reconstruction of major veins, enough decompression of interfascia compartment, proper drainage of would and good surgical skill. Local and general anticoagulation were good to treatment of arterial injuries during and after operation .
The injuries of the femoral arteries were mistreated in 5 cases. The causes of the mistakes were resulted from: the initial cause of the injury was not carefully analyzed; the arterial injury was overlooked by the concomitant injuries, and the improper method of management was selected, as a result, 2 patients died from acute renal failure and the other 3 patients developed the complications of secondary thrombosis of the artery or rupture of the artery at the anastomotic site following repair. Of the 3 patients, 2 patients had recovered following reoperation and the other 1 patient had lost his limb from amputation. It should be emphasized that all of the following key points might avoid the mistakes occurred in the management of the injury of the femoral artery: (1) early diagnosis; (2) debredment of arteral end; (3) in infections wounds, insted of vein transplantation bypass technique should be done.
Abstract During 1960 to 1995, 19 of the 269 casesof arterial injuries in limbs treated developed ischemic contracture (7.06%), in which 14 in the lower limbs and 5 in the upper limbs. In the 19 cases, 3 injured arteries were not treated; 1 had his injured arteries repaired infailure; 5 cases had the concomitant veins injured, and 3 of them had their injured veins ligated in the primary treatment. Only 1 case received fasciotomy in his former treatment in other hospital. Four cases were admitted in our Institute in 14 hours, 8 cases were 34 to 57 hours and 7 were 19 days to 19 months after injury. Seventeen out of the 19 injured ateries and 5 out of the 8 injured vein were repaired. Eight cases received fasciotomy. The follow up ranged from 3months to 28 years (averaged 5 years). Sixteen out of the 17 injured arteries remained patent after repair, and the patency were proved by Bultrasound. The causes of ischemic contracture in these cases were analyzed. It was concluded that in order to prevent the limb from ischemic contracture, it should be emphasized that the accurate diagnosis of the injury of the artery and its concomitant ein be made early, the proper treatment be given to the injured artery and vein,and fasciotomy be done immediately as indicated.
Objective To summarize the experience in treatment and diagnosis of popliteal artery trauma and to determine the factors for amputation. Methods From February 1995 to January 2006, 28 patients with popliteal artery trauma were treated. The disease course was more than 8 hours. Of them, there were 25 males and 3 females, aging from 3 to 53 years. Trauma was caused by traffic accident in 12 cases, by falling from height in 3 cases, by firearm in 2 cases, by sharp instruments in 3 cases, by strangulation in 2 cases and by others in 6 cases. No arteriopalmus or weak arteriopalmus wereobserved in 18 cases and in 8 cases respectively. Popliteal artery exposure or active bleeding was seen in 2 cases; the popliteal arteries were examined by operation in 8 cases; color ultrasound Doppler flow imaging showed color flood flowsignals were through popliteal artery and its branches in 20 cases. Defect sizeof popliteal artery was less than 5 cm in 7 cases and more than 5 cm in 9 cases. End to end anastomosis reconstruction by saphenous vein graft and direct suture was performed in 16 cases and ampulation in 12 cases. The time of the revascularization of the leg was 8-150 hours (mean 31.8 hours). Results All patients were followed up 6 months to 11 years with an average of 4.2 years. In 16 cases given end to end anastomosis reconstruction, 15 cases achieved revascularization and limb survival; lower limb function restored to normal within 1 year in 12 cases; foot drop and ankle joint contracture occurred in 3 casesand the survival rate of limbs was 94%. Amputation was given in 12 of 28 casesbecause of severe trauma. The rate of amputation was 43% and the rate of disability was 54%. Conclusion Popliteal artery trauma should be treated as soon as the diagnosis is made. If the revascularization is more than 8 hours or circulatory compensation is not complete, it will affect the leg survival. Delayed diagnosis and severe traumas are the cause of high rate ofamputation in popliteal artery trauma.
To explore the effectiveness and methods of intervention assistant operation in the treatment of phalanx closed fracture combined with artery crisis. Methods Between August 2002 and December 2008, 24 cases (31 toes) of phalanx closed fracture combined with artery crisis were treated. There were 17 males (22 toes) and 7 females (9 toes), aged from 16 to 62 years (mean, 38 years). The causes of injury included crush and bruise (20 cases), traffic accident (3 cases),and machine twist (1 case). The locations were the first toe (19 toes), the second toe (10 toes), and the third toe (2 toes). The period between injury and hospital ization was 1-10 hours (mean, 6.8 hours). Phalanx angiography was performed by using venous indwell ing needle for dorsal is pedis artery and posterior tibial artery puncture; according to angiography results, proper treatment could be done, then the constrast medium was injected to the artery to observe the blood supply. According to different types and locations of fracture, Kirschner wire and plate were choosen to fix fracture after the blood supply were recovered. Results Two cases (2 toes) received amputation due to necrosis at 4 days and 6 days after interventional therapy, respectively. Twenty-two cases (29 toes) survived. Incision healed primarily in 21 cases. Exudation occurred at wound of 1 case and was cured at 3 weeks after dressing change. Twenty-two cases (29 toes) were followed up 1-6 years (mean, 3.5 years) postoperatively. Two cases (3 toes) felt cool or anaesthesia and could not tolerate even in cold environment. The other toes had no senses of cold pain and paresthesia. Two cases (2 toes) had nonunion and achieved fracture heal ing after grafting bone. The mean union time was 4.5 months (range, 3-6 months) in other cases. Conclusion Intervention assistant operation is an effective measure in the treatment of phalanx closed fracture combined with artery crisis.