VASCUALR INJURY OF THE EXTREMITIES DR SIKHOSANA

Subclavian artery

Axillary artery

Injuries Most due to penetrating trauma In 20% both the vein and the artery are injured 5-14% of the 1st rib fracture are associated with the vascular injury

Surgical repair 1st part of the R subclavian –sternotomy and supraclavicular and the L- 3rd intercostal thoracotomy 2nd and 3rd subclavian and 1st part axillary- supraclavicular and infraclavicular incision 2nd and 3rd axillary deltopectoral groove All should be repaired BRACHIAL PLEXUS INJURY !!!!!!!!

Relation to the plexus

Brachial artery

Significance 0-8% amputation rate - in relation to the profunda brachial Commonly due to penetrating trauma Major morbidity due to nerve injury

Surgical repair Position -supine, abduction and external rotation Incision- bicipital groove MEDIAN NERVE !!!!!!!

Radial and ulnar arteries

Surgical repair Repair if both are injured - larger ulnar - superficial radial Interrupted sutures Compartment syndrome less common compared to the lower limb

Femoral artery

Significance One of the commonly injured vessels Amputation rate following repair- 6.25% Ligation - 50% amputation rate

Femoral incisions Femoral triangle – midpoint of symphysis pubis and the anterior iliac spine Adductor canal – lateral border of the sartorius muscle

Popliteal artery

Significance Most limb threatening vascular injury - tenuous collaterals - worse with blunt trauma and high velocity gunshot In WW II primary ligation resulted in 72.5% amputation

Surgical repair Position- supine, support under the knee, hip externally rotated Incision- ideal for trauma = medial approach

Crural vessels Controversial – about when to repair Problems- they are small - not easily assessable Low chances of injuring all the three vessels