Non iatrogenic paediatric vascular trauma of the extremities and neck

Vascular trauma in children is uncommon. Considering the complexity of these injuries, we have tried to determine their demographic data, the different factors changing their outcome, the different modalities of management, and their outcomes.

We reviewed the medical records of 52 pediatric patients of less than 15 years f age for about ten years (1996 to 2006) .The review was followed by physical examination done by two surgeons. Vascular injuries included blunt and penetrating injuries to the neck and extremities. Their management included conservative management, primary closure, end-to-end anastomosis, graft interpositioning, and fasciotomy.

The patients included 41 males and 11 females and their mean age was 9.7 years (ranging from 3 to 14 years). Males were significantly more (78%) involved. Penetrating upper extremity injuries were the most common cause of vascular injury in the paediatric population (65% on the right side). The most common mechanism was cutting the hand by glass (most of them on the ulnar side). These vascular injuries per se did not cause any disability in the upper extremities. The outcome of these injuries depended more on simultaneous nervous injury and to a lesser extent, on tendon injury. There was no significant long-term difference between ligation and anastomosis of the radial and ulnar arteries. Lower extremity vascular injuries had significantly higher mortality and morbidity.

As the reconstructive procedures to manage vascular injuries are technically difficult, we suggest conservative managements to be applied first. Prompt surgical intervention is necessary if there are any critical signs of ischaemia or unsuccessful conservative management.