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Surgical treatment of vascular trauma associated with extensive adjacent tissue lessions


Author: Castraveţ Andrei
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2009
Scientific adviser: Nicolae Gladun
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 29 April, 2009
Approved by NCAA on the 18 June, 2009

Abstract

Adobe PDF document – 1.37 Mb / in romanian

Keywords

Surgery of the arteries – arterial injuries – vascular trauma – blunt injuries – war vascular injuries – extraanatomic by-pass

Summary

This work emphasizes the surgical treatment results of 84 patients with vascular trauma associated with extensive tissue lesions, infected wounds and purulent collections in the period 1991-2007. All patients were included in the study according to the following criterion – reestablishment of magistral arterial blood flow.

All patients were divided into two groups, according to the used treatment method: the control group – 29 patients, to whom traditional surgical methods were used, and the study group - 55 patients, where extraanatomical by-passes or the in situ revascularization with open wound method have been used.

In the control group the wounds adjacent to the repared vessel were extensively cleaned from necrotic tissues, drained and suttured, including the skin, covering completely the the site of vascular reconstruction.

In the study group all wounds from the site of vascular repairs were left open or partially closed for postoperative monitoring or repeated debridement if necessary. In 7 cases from this group, extraanatomic by-passes were performed.

Revascularizations with open wounds were performed in a series of variants. In cases with skin, adipose and muscular tissue defects arterial repair and extensive debridement has been performed with leaving the wound open. This method was used in 35 cases (63,6%). Another variant consists in the closure of the wound through which the vessel has been accessed leaving open the paravasal site where tissues are of dubious viability using aditional incisions. Such a variant has been used in 13 cases (23,6%) from the study group.

In 14 patients (48,3%) from the control group, arterial ligations where performed due to haemorrhage per erosio, thus 10 amputations were made. Also there have been made 3 amputations due to necrotico-purulent complications. Thus, 13 amputations (44,8%) were made in the control group. There had been four lethal cases due to erosive haemorrhages and progression of necroticopurulent processes.

In the study group there were two erosive haemorrhages in the late postoperative period, which were managed by application of autovenous patches, drainage and closing the granulating wound. There have been no arterial ligation or/and limb amputations after such complications in the study group.

Adequate revascularization was possible, by reestablishment of magistral arterial blood flow, in patients with vascular trauma associated with extensive adjacent tissue lesions and infected wounds, due to elaboration and implementation of revascularization methods with open wounds, avoiding arterial ligation, limb amputations and deaths.