Surgical management of traumatic injuries to the tibial arteries

Altogether 60 patients with traumatic injuries to the tibial arteries were entered into the study. Twenty-four patients presented with gunshot, 24 with stab and incised, 10 with contused and lacerated wounds, and 2 patients had blunt traumas. Thirty-nine patients were admitted to the clinic within the period as long as 8 hours since the time of wounding, 9 patients within 8 to 24 hours, and 12 patients within the period as long as one to 15 days. 39 patients had been rendered first medical aid at other treatment institutions. It was established that prehospital diagnostic, tactic and technical errors had been made in 25 of the 39 patients. All the patients were distributed into three groups: group I (n=8) included patients with isolated injuries of one of the tibial arteries; group II (n=11) with injuries of two arteries and group III included patients with damage to all three arteries. In group I, circulation remained made for irrespective of the times of ischemic state existence. In groups II and III, all the patients demonstrated circulatory decompensation. Surgical management depended on the severity of the general condition and the degree of limb ischemia. Primary amputation was indicated to 11 (18.3%) patients (humid gangrene was diagnosed in 5 patients, severe trauma with major defects of soft tissues and bone fractures in 6 patients). The remaining 49 victims underwent different surgical interventions such as ligation of the vessel at injury to one artery (23); revascularization (22); fasciotomy, hematoma evacuation and reposition of the bones in an isolated form (4). Five (10.2%) patients required secondary amputation. Beneficial results with complete circulatory compensation were obtained in 44 (73,3%) patients. The overall amputation rate accounted for 26.6%.