TABLE 2551 Clinical Manifestations of Extremity Vascular Trauma

FIG. 255-1. Algorithm for the evaluation of an injured extremity for vascular trauma. (Adapted from Frykberg: Advances in diagnosis and treatment of extremity trauma. Surg Clin North Am 75:207, 1995.

Duplex ultrasound has become a popular modality in the management of proximity injuries without evidence of arterial injury. Recent advances in duplex ultrasonography have shown highly accurate rates of detecting occult arterial injury (vide infra). Some clinicians use duplex ultrasound to distinguish between patients who require observation and those who can safely be discharged home.

Although venous trauma can bleed profusely, management by either ligation or reanastomosis often yields similar results. 6 Asymptomatic venous injury rarely results in long-term morbidity. During the initial trauma resuscitation, attempts should not be made to clamp or ligate bleeding vessels in an attempt to control bleeding. Nerves are bundled with vascular structures and can be easily damaged by blind clamping or ligation. Profuse bleeding should be initially controlled with direct pressure.

Although arterial injury is the most dramatic result of penetrating extremity injury and represents the most immediate life threat, injuries to major nerves are the most likely to lead long-term disability. Fortunately, 70 percent of peripheral nerve injuries noted during the initial examination recover completely within 6 months of the initial injury. A neuromuscular exam of the extremities should indicate both muscular and sensory function ( T.a.b.ie... .2.55-2) and check for evidence of compartment syndrome. Patients with suspected nerve, orthopedic, or vascular injury or compartment syndrome should be immediately evaluated by surgical subspecialists.

V^TlIht 1 III L I II

V^TlIht 1 III L I II

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