Tests

What are the tests to be ordered?

These would include:

• Blood tests including cross matching of blood
• Chest X-Ray
• ECG
• Possibly Echocardiogram
• X-ray of the limb to see if there are any fractures
• CT Scan or MRI is ordered if soft tissue injury is expected but it is not needed in most cases of Vascular Trauma injury.
• CT Angiography is generally advised provided the kidney function is not hampered. This will tell us of the anatomy of the arterial tree and the site of injury of the artery.
• Ankle-Brachial Index (ABI) is normally not done but may be done in centers where angiography facilities are not available. Here the doctor takes a normal blood pressure in the arm and compares it to the pressure in the injured leg.
• Pulse Oximeter shows the level of blood oxygen in the limb beyond the injured area. It is not very diagnostic as the patient may be in shock.

Is it possible to avoid surgery?

It is only possible in cases where there is no arterial injury or fracture and only soft tissue injury.

Will the surgery be performed immediately?

The patient has to be first stabilized by giving fluids and fully resuscitated. His cardiac condition must be improved if it is compromised. If he is a diabetic his sugar must be brought under control. His electrolytes have to be corrected before surgery. Always remember “Life is more important than limb”. You do not want to rush into surgery and lose an unstable patient.

For how long can the limb survive?

The golden period is six hours after which the muscles of the limb start to go into irreversible damage and as time goes no it becomes progressively more difficult to save a limb.

What would be done in surgery?

If there is a fracture it has to be stabilized before the blood supply is restored. This could be by external fixation if the wound is open or an internal fixation if there is no open wound but the surgeon may prefer external fixation.

How is the blood supply restored?

This is by repair of the vessel or a bypass. The original anatomy is restored by joining the cut ends.

At times a patch may be used to cover the hole in the artery.
or if the gap is too much then graft from the patient’s body or from outside is put between the cut ends to restore the circulation.

What should be done if there are no experts to repair the injured vessel?

If the facility of repair of the vessel is not available in your área and the center where it is available is quite far away then an attempt to salvage can be made by doing a fasciotomy. Here the tense skin is cut to remove the pressure on the injured vessels. This is only an attempt to save the limb.

Content Reviewed by – Dr. Jaisom Chopra