Peripheral vascular injuries and their management in accra
1Department Of Surgery, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana.
Insights
Delayed recognition of vascular injuries in Ghana leads to poor outcomes. Early intervention and improved diagnostic skills are crucial for better patient management and limb salvage.
Area of Science:
- Vascular Surgery
- Trauma Management
- Public Health
Background:
- The incidence of vascular injuries in Ghana is underestimated due to underreporting.
- Peripheral vascular trauma presents significant challenges in diagnosis and management.
Purpose of the Study:
- To review the patterns of peripheral vascular injuries.
- To analyze referral, presentation, and management of these injuries at Korle-Bu Teaching Hospital, Accra.
Main Methods:
- Retrospective review of 52 patients with peripheral vessel injuries from January 1989 to March 2005.
- Analysis of injury mechanisms, types, associated injuries, and management outcomes.
Main Results:
- Penetrating trauma was the predominant injury mechanism (82.7%).
- Arterial injuries (63.5%) were most common, with brachial artery injuries being frequent.
- Late presentations (40.4%) and delayed referrals were significant issues, impacting outcomes.
Conclusions:
- Inability of initial medical personnel to recognize vascular injuries causes significant referral delays.
- Effective treatment is often achievable without expensive, sophisticated investigations.
- Improved diagnostic skills and timely referrals are essential for better patient outcomes.
Summary Background:
The true incidence of vascular injuries in Ghana is not known on account of low reporting.
Objective:
We performed a study aimed at reviewing the pattern of injuries to peripheral vessels, and also the pattern of referral, presentation and management of these injuries at the Korle-Bu Teaching Hospital, Accra.
Method:
The study covered the period of January 1989 to March 2005 and involved a review of all peripheral vessel injuries referred for vascular surgical opinion.
Results:
Fifty two (52) patients with aged between 13-50 years were reviewed. Penetrating trauma (82.7%) and blunt trauma (11.5%) were the commonest modes of injury. Arterial injuries (63.5%) and combined arterial and venous injuries (23.1%) were the commonest forms of injury. Brachial artery injuries were the commonest injuries seen. Associated nerve injuries occurred in 25% of patients most of whom also had brachial artery injuries. Late presentations of false aneurysms and arteriovenous fistulae were seen in 40.4% patients. There were delays in referring patients (range 1 hour to 4 years). Vascular investigations like angiograms and duplex scanning were obtained in only 25.0% of patients. Vascular reconstruction was successful in 84.6% patients and 7.7% of patients required major limb amputation and an equal number of patients died from other injuries.
Conclusion:
There is undue delay in referring patients with vascular injuries for intervention due to the inability of the initial attending medical personnel to recognize these injuries. Most of these injuries can be adequately treated without the use of sophisticated investigations, which are usually expensive.
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