1. VASCUALR INJURY OF THE EXTREMITIES
DR SIKHOSANA

2. Subclavian artery

3. Axillary artery

4. 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

5. 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 !!!!!!!!

6. Relation to the plexus

7. Brachial artery

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

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

10. Radial and ulnar arteries

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

12. Femoral artery

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

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

15. Popliteal artery

16. 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

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

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