Trauma is a disease that strikes down our youngest and potentially most productive members of society.

Hard signs for Vascular injury

• Active haemorrhage / Bleeding.
• Large, expanding or a pulsatile hematoma
• Bruit or thrill
• Absent pulses
• Distal ischaemia (6 P’s – pain, pallor, paralysis, poikilothermia, paresthesia, pulselessness)

Prognostic Factors for Limb Salvage:

• Time: Golden period – 6 hours – if the vascular repair is done within 6 hours after injury, best possible outcome with return of normal muscle function is possible.
• Mechanism: Crush /Degloving / Clean cut / amputated etc.
• Anatomical location: Single or multiple segment involvement.
• Associated Injuries: Nerve – Motor or Sensory deficits, Bone injury, Muscle function loss.
• Physiological status: Presence of elderly age, Active tobacco usage, Diabetes, Hypertension, Prior history of Stroke, Cardiac disease etc.
• Clinical Presentation: Presence of sensations, movements, Pallor, Colour and temperature.

Outcomes:

It is extremely important that the whole team--orthopedics, trauma, vascular surgery, rehab, physiotherapy, plastic surgery nursing and--most importantly--the patient and family---ALL agree on the plan before proceeding.

• About 95% of the limbs can be salvaged if intervened in the right time.
• Patients who suffer vascular injuries should be referred to specializedcentersimmediately.
• Decisive management of peripheral vascular trauma will maximize limb salvage and patient survival.
• MESS score should be evaluated in every patient. Primary amputation to be considered if MESS > 7 in grossly mangled limbs.
• Early fasciotomy to be liberally used.