van Rensburg Kewen, Steyn Wilme, Cassimjee Ismail, Moeng Maeyane Stephens
Department of Surgery, Division of Vascular Surgery, Charlotte-Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.
Department of Surgery, Division of Trauma Surgery, Charlotte-Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):63. doi: 10.1007/s00068-024-02691-9.
To determine modifiable and non-modifiable factors contributing to limb loss in PAI the relevance and accuracy of published scoring systems for PAI within a South African State hospital.
Retrospective review of patients (> 18 years) with PAI, presenting to CMJAH trauma unit from 1 January 2017 to 31 December 2022.
Sixty-four patient records were analysed. Thirty (46.9%) had blunt trauma and thirty-four (53.1%) had penetrating trauma. Gunshot wounds (GSW) were the most common mechanism of injury (MOI). Blunt PAI had a 40% amputation rate and penetrating trauma, 33.3%. Forty-seven (73.4%) had a delay to surgery of > 6 h. The mean time to arrival at our emergency department was 478 min, and the mean time from arrival to surgery was 368 min (total delay of 838 min). The primary amputation rate was 28.6%, and 63.5% had successful limb salvage surgeries. The secondary amputation rate was 7.8%.
Compared to international literature, our rate of primary amputation is high (10% vs. 28.8%) and prolonged ischaemia is the likely cause. Only 17 (26.6%) patients presented before 6 h. Of the 45 patients that had an attempt at revascularisation, 7.8% had a secondary amputation. Thus, despite prolonged ischaemia, revascularisation should be attempted in patients with at least two viable compartments on fasciotomy. The MESS and POPSAVEIT scoring systems should not be relied on in patients with delayed presentations. Strengthening referral triage for suspected PAI to Level 1 Trauma centres directly will decrease the delays and likely improve the outcomes.
确定导致南非一家国立医院中创伤性肢体缺血（PAI）患者肢体缺失的可改变和不可改变因素，以及已发表的PAI评分系统在该医院中的相关性和准确性。
回顾性分析2017年1月1日至2022年12月31日期间在CMJAH创伤科就诊的PAI患者（年龄>18岁）。
分析了64例患者的记录。30例（46.9%）为钝性创伤，34例（53.1%）为穿透性创伤。枪伤（GSW）是最常见的损伤机制（MOI）。钝性PAI的截肢率为40%，穿透性创伤的截肢率为33.3%。47例（73.4%）患者手术延迟>6小时。到达我院急诊科的平均时间为478分钟，从到达至手术的平均时间为368分钟（总延迟838分钟）。一期截肢率为28.6%，63.5%的患者成功保肢手术。二期截肢率为7.8%。
与国际文献相比，我们的一期截肢率较高（10%对28.8%），缺血时间延长可能是原因。只有17例（26.6%）患者在6小时内就诊。在45例尝试血管重建的患者中，7.8%进行了二期截肢。因此，尽管缺血时间延长，但对于筋膜切开术中至少有两个存活肌室的患者，仍应尝试进行血管重建。对于就诊延迟的患者，不应依赖MESS和POPSAVEIT评分系统。直接加强将疑似PAI患者转诊至一级创伤中心的分诊工作将减少延迟，并可能改善治疗结果。
