The majority of injuries (41%) were due to high energy blasts from artillery shells and mortars, rocket propelled grenades, high explosive bombs and anti personnel mines. Cuts and stabs accounted for 26% while 17% were due to gunshot wounds. These included high velocity rifles & machine guns; low velocity shot guns and improvised trap guns. Other causes included road traffic accidents (RTA), industrial accidents and iatrogenic trauma following arterial catheterisation. Civilian trauma accounted
Selleckchem Hydroxychloroquine for 54% of injuries while 46% were related to the military conflict. Table 1 Vessels injured by cause of injury Blast injuries Cuts/stabs Gunshots RTAs Industrial accidents Iatrogenic Total (%) Axillary artery 01 01 02 (2.5%) Brachial artery 11 01 01 01 03 01 18 (22%) Radial artery 12 12 (15%) Ulnar artery 07 07 (8.5%) Femoral artery 06 01 02 01 02 12 (15%) Popliteal artery 08 05 04 17 (21%) Tibial arteries 02 03 05 (06%) Femoral vein 01 01 02 (2.5%) Popliteal vein 03 01 04 (05%) Axillary vein 01 01 02 (2.5%) 33(41%) 21(26%) 14(17%) 07(9%) 03(3.5%) 03(3.5%) 81 (100% Vessels injured and type of presentation All named extremity vessels presented with injuries and were repaired (table Palbociclib mw 1). The brachial artery was the most commonly
injured vessel (22%) followed by popliteal (21%), femoral (15%) and radial (15%) arteries. Indications for referral were acute ischaemia in 36(44%), bleeding in 35 (43%) and traumatic pseudo-aneurysms
in 10(13%). In patients presenting with bleeding, the commonest vessels injured were the radial and ulna arteries (Table 2). Table 2 Presentations and method of management Vessel injured Direct repair Vein graft PTFE graft bypass Endo-vascular stenting Primary amputation N% 1. Injuries presenting with bleeding Radial/Ulnar arteries 19 19 (54%) Brachial artery 01 04 05 (14%) Femoral artery 01 01 02 (06%) Axillary artery 02 02 (06%) Major limb veins Cediranib (AZD2171) 04 03 07 (20%) Total 35(100%) 2. Injuries presenting with acute ischaemia Popliteal artery 03 09 05 17 (47%) Brachial artery 02 07 01 10(28%) Femoral artery 01 02 01 04(11%) Crural arteries 05 05(14%) Total 36(100%) 3. Injuries presenting as psuedoaneurysms Femoral artery 02 03 01 06 (60%) Brachial artery 01 02 03 (30%) Popliteal artery 01 01 (10%) Total 10(100%) Total 35 39 01 01 06 81 N.B Some patients had multiple repairs. Delays in intervention, methods of repair and limb salvage For injuries presenting with bleeding, median time to revascularization was 5.5 hours (range 2-16) and all limbs were salvaged. In injuries presenting with acute ischaemia, popliteal injuries were the most common (Table 2) and 80% of such limbs were revascularized more than 6 hours after injury.