Khan Mohammad Iqbal, Zafar Afsheen, Khan Najam, Saleem Mohammad, Mufti Naveed
Department of Surgery, Islamic International Medical College, Rawalpindi.
J Coll Physicians Surg Pak. 2006 Dec;16(12):773-6.
To describe the pattern of mine blast limb injuries in civilian population of Kashmir, to evaluate the outcome of tissue sparing surgical intervention in these injuries and to determine the sensitivity of hand-held percutaneous Doppler for tissue viability.
Descriptive study.
Combined Military Hospital, Muzaffarabad and Islamic International Medical College Hospitals at Rawalpindi/Islamabad from November 1997 to May 2005.
One hundred and three patients who sustained mine blast injuries to upper or lower limbs, along side the line of control between the Indian-held Kashmir and Azad Kashmir, regardless of age and gender, were included in this study. Patients who already had amputation after injury at some other place were excluded. All patients were initially managed in emergency and had more than one surgical intervention. Transcutaneous Doppler was used to evaluate the vascularity of the remaining tissue. All patients were operated under spinal or general anaesthesia and had repeated debridements followed by skin cover by split skin graft, full thickness skin graft or rotational flaps. Every patient received at least 5 days course of antibiotics and tetanus prophylaxis. Postoperative rehabilitation and follow-up was conducted for at least 6 months after discharge from the hospital.
Mean age of victims in this study was 22 years. Out of 103 patients, 72 (69.9%) received initial wound care in the peripheral primary health care centre but were not amputated while 31 patients (30%) were just dressed and referred for further treatment at tertiary care hospitals. Eighty-five patients (82.5%), out of the total, had some sort of traumatic amputation at presentation due to the original injury. That included loss of limb below knee in 19 (18.45%) patients, at distal tibiofibular region in 13 (12.6%), mid tarsal amputations in 39(37.9%), and hemi foot amputation in 15 (14.6%) patients. Nine (8.7%) patients had losses of two or less than two toes, 1 (0.97%) patient had injury at mid palmer region, and 5 (4.9%) patients had 2 fingers traumatic amputation. Eighteen (17.5%) patients had soft tissue ( with or without bony injury) injury only without any actual traumatic amputation. Infection rate was 27% in patients who did not have wound care in the periphery. Those who had wound toilet in-the peripheral hospital had infection rate of 16%. Two patients developed fulminating multi-resistant progressive infection requiring below knee amputation.
Conservative wound debridement and early skin coverage by different means and preserving maximum soft tissues and bone results in functionally and cosmetically better limb in victims of land mine.
描述克什米尔平民群体中地雷爆炸所致肢体损伤的模式，评估针对这些损伤采取的保留组织手术干预的效果，并确定手持式经皮多普勒仪对组织活力评估的敏感性。
描述性研究。
1997年11月至2005年5月期间，穆扎法拉巴德联合军事医院以及拉瓦尔品第/伊斯兰堡的伊斯兰国际医学院附属医院。
本研究纳入了103例在印控克什米尔和自由克什米尔控制线沿线遭受上肢或下肢地雷爆炸伤的患者，不限年龄和性别。排除在其他地方受伤后已行截肢手术的患者。所有患者最初均在急诊接受处理，且接受了不止一次手术干预。使用经皮多普勒仪评估剩余组织的血管情况。所有患者均在脊髓麻醉或全身麻醉下接受手术，反复进行清创，随后采用中厚皮片、全厚皮片或旋转皮瓣进行皮肤覆盖。每位患者均接受至少5天的抗生素治疗及破伤风预防。出院后进行至少6个月的术后康复及随访。
本研究中受害者的平均年龄为22岁。103例患者中，72例（69.9%）在周边基层医疗中心接受了初始伤口处理但未行截肢，而31例患者（30%）仅进行了包扎并被转诊至三级医院接受进一步治疗。在全部患者中，85例（82.5%）因原发损伤在就诊时存在某种形式的创伤性截肢。其中包括19例（18.45%）患者膝关节以下肢体缺失，13例（12.6%）患者在胫腓骨远端区域截肢，39例（37.9%）患者跗骨中部截肢，15例（14.6%）患者半足截肢。9例（8.7%）患者失去两个或少于两个脚趾，1例（0.97%）患者手掌中部受伤，5例（4.9%）患者两根手指创伤性截肢。18例（17.5%）患者仅存在软组织损伤（伴或不伴骨损伤），无实际创伤性截肢。未在周边接受伤口处理的患者感染率为27%。在周边医院接受伤口清理的患者感染率为16%。两名患者发生暴发性多重耐药进行性感染，需要进行膝关节以下截肢。
通过不同方式进行保守性伤口清创和早期皮肤覆盖，最大程度保留软组织和骨骼，可使地雷爆炸受害者的肢体在功能和外观上恢复得更好。
