Wang Xiaoqing, Zhao Xu, Du Guoqiang
Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Post-doctoral Research Station of Clinical Medicine, Liaocheng People's Hospital, Liaocheng, China.
Transl Pediatr. 2024 Jul 31;13(7):1266-1272. doi: 10.21037/tp-23-553. Epub 2024 Jul 29.
Traumatic vascular injuries in the pediatric patient population are uncommon, especially firecracker blast injuries. Extremities are more frequently affected. Vascular lesions in children have unique characteristics compared to adults, including small vessel diameters, continued growth and development, and susceptibility to vasospasm. There are no clear guidelines for vascular repair and postoperative drug therapy. This may present some challenges during treatment. The study's purpose is to retrospectively analyze a case of femoral artery and vein injuries in a child due to firecracker explosion, and to summarize the characteristics of femoral artery and vein rupture in children and the diagnostic and therapeutic experience.
We reported a 9-year-old boy with a firecracker injury to the perineum resulting in a left femoral artery and femoral vein rupture. In particular, the wound from firecracker explosion is located at the point of body projection of the spermatic cord, rather than the femoral artery and femoral vein. Emergency compression of the wound to stop bleeding provided an opportunity for subsequent surgical treatment. The intraoperative exploration revealed that the left femoral artery was mostly dissected along a 3-cm long section with a disfigured wall, and the left femoral vein was partially dissected with its anterior wall partially disrupted and missing. The child was subjected to left femoral artery autologous great saphenous vein interposition and left femoral vein repair with patch plasty. The patient had a successful surgery with good follow-up.
Pediatric femoral arteriovenous injury is a rare and complex condition, often associated with critical complications, challenging surgical interventions, and a high risk of mortality and disability. The location of body wounds may contribute to delayed diagnosis of the condition, emphasizing the importance of timely physical examination for early diagnosis. Timely and accurate vascular repair is paramount for saving lives and minimizing the risk of limb amputation. Long-term postoperative follow-up is necessary to monitor the patency of the repaired vessels and promptly detect any complications.
小儿患者群体中的创伤性血管损伤并不常见，尤其是鞭炮爆炸伤。四肢更常受到影响。与成人相比，儿童的血管病变具有独特特征，包括血管直径小、持续生长发育以及易发生血管痉挛。目前尚无明确的血管修复及术后药物治疗指南。这可能在治疗过程中带来一些挑战。本研究的目的是回顾性分析1例儿童鞭炮爆炸导致股动静脉损伤的病例，总结儿童股动静脉破裂的特点以及诊断和治疗经验。
我们报告1例9岁男孩，会阴部鞭炮伤导致左股动静脉破裂。特别指出的是，鞭炮爆炸伤口位于精索体表投影点，而非股动静脉处。紧急压迫伤口止血为后续手术治疗创造了机会。术中探查发现，左股动脉大部分沿3厘米长的一段被剥离，血管壁毁损，左股静脉部分被剥离，其前壁部分破损缺失。该患儿接受了左股动脉自体大隐静脉移植术及左股静脉补片修补术。手术成功，随访情况良好。
小儿股动静脉损伤是一种罕见且复杂的病症，常伴有严重并发症、具有挑战性的手术干预以及高死亡率和致残风险。身体伤口的位置可能导致病情诊断延迟，强调了及时体格检查对于早期诊断的重要性。及时、准确的血管修复对于挽救生命和降低肢体截肢风险至关重要。术后长期随访对于监测修复血管的通畅情况并及时发现任何并发症是必要的。
