Limb XXXX associated with limb @entity174 : clinical presentation, assessment and management.

@entity1 @entity174 @entity254 @entity4218 @entity1317
OBJECTIVES: Review of limb @entity1317 associated with limb @entity174 . DESIGN: Retrospective study. SETTING: University Hospital. MATERIALS AND METHODS: The clinical presentation, assessment and management of 25 @entity1 with upper (seven) and lower (18) limb @entity1317 associated with limb @entity174 has been retrospectively reviewed. MAIN RESULTS: Five @entity1 presented with life threatening injuries and classic signs of @entity4218 , 15 @entity1 had an obvious limb @entity1317 , and 5 presented with a suspected limb @entity1317 . The site of arterial damage was: superficial femoral (4); popliteal (11); tibioperoneal trunk (3); anterior tibial (4); posterior tibial (3); peroneal (2); axillary (1); brachial (5); radial (4); and ulnar artery (4). The types of arterial repair were: autogenous vein interposition or bypass grafting (17); P.T.F.E. (2); end-to-end @entity254 (14); and ligation (8). The popliteal vein was injured in six cases, repaired in four and ligated in two; the superficial femoral vein was injured in four cases, repaired in three and ligated in one; and the axillary vein was injured in one case and was ligated. Primary nerve repair was employed in six out of seven injured nerves. Skeletal fixation preceded vascular repair in 21 @entity1 and in four a Javid shunt was used. Intraoperative fasciotomy was performed in 12 out of 18 @entity1 with lower limb ischaemia. Completion arteriography revealed residual thrombi in the distal foot of four @entity1 , in whom intraarterial thrombolysis was effective. During the follow-up period of 1.5 to 2 years, the upper and lower limb preservation rate was 100 and 89%, respectively. The upper limb function was judged excellent in five @entity1 , good in one and fair in one. In the lower limbs it was excellent in 11 @entity1 , good in three, fair in one and poor in one. CONCLUSIONS: To ensure life and functional limb salvage of @entity1 with devastating @entity1317 , a well organised multidisciplinary approach is necessary.
