Vascular injuries associated to fractures or dislocations

In complex injuries of limbs vessels are frequently involved. Immediate identification and proper treatment of such injuries are fundamental, since a late diagnosis and treatment frequently result in loss of limb or in permanent disability. During the last ten years (1969-1979) 35 patients with vascular injuries associated with comples trauma of limbs were treated in our Dept. In 80% of patients the injuries resulted from traffic accidents, in 20% from other causes. In 30% of patients pre-operatory arteriography was performed to recognize the exact site of the lesion, in other cases the site of the vascular injury was obvious. If distal ischemia persist after reduction of associated dislocation or fracture of the knee, we never made a clinical diagnosis of arterial spasm, but we have always performed the surgical exploration of the vessels. In 25% of arterial injuries we made the restoration of blood flow by end-to-end anastomosis; in 2,5% by autologous venous patch and 47,5% by reversed saphenous vein graft. The most involved arteries were: Superficial femoral, popliteal and brachial artery. An overall amputation of 12% was requested, when the period of limb ischemia was prolonged over 8 hours and when sotf tissues were severely damaged.