The objectives of the treatment of patients with vascular trauma

Abstract

Aim of the study: Assessment of the possibility of surgical treatment of vascular trauma using the open wound method. Material and methods: During the period of 1990-2011,66 patients with vascular injuries associated with bacterial contamination and délabrante wounds were treated using the open wound method. Extraanatomic by-passes with reversed internal saphenous graft have been aplied to 12 patients. The initial wound was left opened for proper drainage and repeated debridement. In 54 cases the extraanatomic by-pass was not possible for such technical reasons as insufficient diameter and length of the autologous saphenous graft, considerable tissue destruction and contamination in the region with opportunity to pass the graft. In these patients open wound vascular repair was used. Results: During the postoperative period 2 cases of erosive bleeding occurred, which were stopped by applying autovenous patches, adequate wound drainage and suturing on granulation tissue. Such interventions as arterial ligation and amputations were not necessary. Conclusion: In cases of vascular trauma associated with extended damage and important bacterial contamination of the adjacent tissue, it is preferable to perform extraanatomic by-passes within viable and uncontaminated tissues. In cases when the by-pass cannot be performed, revascularization in situ using the open wound method is required. Access for control and repeated debridement of the tissues ajacent to the repaired vessel is realized through the unsutured postoperative wound or through large additional contraperture incisions.