Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series.

BACKGROUND: Severe extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center. METHODS: This study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization. RESULTS: Thirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5. CONCLUSIONS: The limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.

Temporary Intravascular Shunting Using a Pruitt-F3 Carotid Shunt for Traumatic Popliteal Artery Injury.

Temporary intravascular shunting (TIVS) is an effective method to shorten the duration of ischemia and contribute to limb salvage in the treatment of popliteal artery injury (PAI). Traditionally used shunt tubes require ligation or clamping to the blood vessel, which has the disadvantage of causing secondary damage to the vessel. We present two cases in which TIVS was performed using the Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, Mass.) for traumatic PAI and report the effectiveness of the method. Two patients diagnosed with PAI had pallor of the feet and complete motor and sensory paralysis. The patients were immediately transferred to the operating room. PAI was confirmed in one patient by the medial approach and in the other by the posterior approach. In both patients, the vascular injury extended to the vicinity of the bifurcation into the anterior tibial artery. TIVS was performed using a 9Fr Pruitt-F3 Carotid Shunt. In both patients, the color tone of the feet improved. No vascular damage occurred secondary to TIVS. The popliteal artery was reconstructed using a great saphenous vein graft on the contralateral lower extremity, and the limb was salvaged. If the artery is injured near its bifurcation, it may be possible to preserve the branch vessel by using the Pruitt-F3 Carotid Shunt for TIVS.