Radonic V, Baric D, Petricevic A, Kovacevic H, Sapunar D, Glavina-Durdov M
Surgical Clinic, Split Clinical Hospital Centre, Croatia.
Br J Surg. 1995 Jun;82(6):777-83. doi: 10.1002/bjs.1800820620.
Twenty-eight patients with military crural vascular injuries are presented. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 min). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3-47 (mean 14) days. Hyperbaric oxygenation therapy was used in conjunction with surgery and antibiotic therapy in 13 of the 28 patients. Explosive injuries were found in 14 patients and high-velocity missile injuries in nine; associated fractures were present in 20. Twenty of the 28 patients with crural vascular injuries had combined arterial and venous injuries, while eight had isolated arterial injuries. Twenty-five patients with distal ischaemia required arterial repair; five late amputations resulted. Military crural vascular injuries should be treated with soft tissue debridement, removal of foreign material, and microvascular arterial and concomitant vein reconstruction. This should be followed by external skeletal stabilization for bony and/or soft tissue instability, with fasciotomy for any associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric oxygen therapy reduced the amputation rate following combat-related crural vessel injuries.
本文介绍了28例军事性小腿血管损伤患者。在接受即刻修复的组（21例患者）中，创伤与手术之间的时间间隔为20分钟至30小时（平均8小时30分钟）。在接受延迟修复的患者（7例）中，创伤与手术之间的间隔为3 - 47天（平均14天）。28例患者中有13例在手术和抗生素治疗的同时使用了高压氧治疗。14例患者为爆炸伤，9例为高速导弹伤；20例伴有骨折。28例小腿血管损伤患者中，20例合并动脉和静脉损伤，8例为单纯动脉损伤。25例远端缺血患者需要进行动脉修复；5例患者最终截肢。军事性小腿血管损伤应采用软组织清创、清除异物以及微血管动脉和伴行静脉重建进行治疗。随后应对骨骼和/或软组织不稳定进行外固定架固定，对任何相关的骨筋膜室综合征进行筋膜切开术。伤口应敞开，延迟缝合或进行植皮。人们认为高压氧治疗降低了与战斗相关的小腿血管损伤后的截肢率。
