Vascular injuries and replantation

Abstract

This chapter covers the diagnosis and management of blood vessel injuries likely to be encountered when dealing with disaster-related orthopedic trauma. The focus is primarily on the expedient diagnosis and management of arterial injuries to the extremities. While the intricacies of definitive arterial and venous diagnosis and repair are beyond the scope of this chapter, we will outline the diagnosis of vascular injuries with emphasis on the physical examination and discuss the field management of hemorrhage and ischemia. We will cover vascular injury management techniques primarily constituting ‘vascular damage control,’ consisting of initial life and limb salvage maneuvers. A basic vascular surgical anatomy and technique reference can be invaluable when planning emergency surgery and will help to clarify the exposures and techniques mentioned below. Finally, attention is given to the identification and management of the physiologic consequences of Ischemia-Reperfusion (I-R) and a discussion of the vascular issues encountered in the evaluation and treatment of mangled or traumatically amputated extremities.