Αντιμετώπιση τραυματικών κακώσεων περιφερικών...

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    18-Feb-2017
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    Healthcare

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Transcript of Αντιμετώπιση τραυματικών κακώσεων περιφερικών...

  • 1, 1, 1, 2, 2, 3, 3, 2

    1: ... . 2: ... . 3: ... .

  • 80%

  • SHOCK

  • Diagnosis of Vascular injury Hard signs Loss of distal pulse Expanding hematoma Bruit or thrillVisible arterial bleedingDistal ischemia

    Soft signs Distal neuroinjuryDiminished distal pulse/ABI ankle/ brachial index Stable hematoma Significant blood loss at scene

  • STENT GRAFT

  • Diagnosis of Vascular injury Hard Signs of Distal ischemia The 5 Ps:

    painpallor paralysisparesthesias poikilothermy

    or coolnessKnee Dislocation

  • Management of Complex Extremity Trauma Initial Fracture Stabilization and Fixation

    has been advocated in past years, due to concerns that an established vascular repair will be disrupted by subsequent orthopaedic manipulation

  • Management of Complex Extremity Trauma If Revascularization is performed first

    Clinical studies have shown a substantially higher rate of limb salvage

    compared with those in which it is delayed until the skeleton is addressed

    BUT this is true only forUndisplaced, stable blunt fractures

  • Management of Complex Extremity Trauma Definitive vascular repair should be delayed in cases of

    unstable or severely comminuted fractures dislocations segmental bone loss severe soft tissue destruction and contamination

  • Management of Complex Extremity Trauma Immediate restoration of perfusion

    Temporary intraluminal shunting until skeletal stabilization and soft tissue debridement has been completed

  • RTA, Open IIIc Humerus Fracture

    Vascular Surgeons Orthopaedic Surgeons Plastic Surgeons

  • Popliteal artery injury Shunt in place

  • The Decision to Amputate

  • The Decision to AmputateRisk factors for amputation

    Gustilo III-C injuriescomminuted, open tibial-fibular fractures with vascular disruptionSciatic or tibial nerve, or 2 of the 3 upper extremity nerves, anatomically transectedProlonged ischemia (>46 hours)/muscle necrosisCrush or destructive soft tissue injurySignificant wound contaminationMultiple/severely comminuted fractures/segmental bone lossOld age/severe comorbidityLower versus upper extremityApparent futility of revascularization / failed revascularization

  • Orthopaedic Scoring SystemsEarly Total Care (ETC)

    Injury Severity Score (ISS), (NISS)

    Mangled Extremity Severity Score (MESS)

    Damage Control Orthopaedics (DCO)

  • G. Papanikolaou Hospital

    Vascular Surgeons Orthopaedic Surgeons