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Traumatic extremity arterial injury in children: epidemiology, diagnostics, treatment and prognostic value of Mangled
Philipp Mommsen1, Christian Zeckey, Frank Hildebrand
1Trauma Department, Hannover Medical School, 30625 Hannover, Germany. mommsen.philipp@mh-hannover.de
Insights
Pediatric arterial injuries are rare but challenging. The Mangled Extremity Severity Score (MESS) effectively guides limb salvage decisions in children with traumatic extremity vascular injuries.
Area of Science:
- Pediatric vascular surgery
- Trauma surgery
- Orthopedic trauma
Background:
- Traumatic pediatric arterial injuries present unique challenges due to anatomical and physiological differences in children.
- These injuries are infrequent, necessitating specialized knowledge for diagnosis and management.
- Evaluating the prognostic value of scoring systems like the Mangled Extremity Severity Score (MESS) is crucial for treatment planning.
Purpose of the Study:
- To investigate the epidemiology of traumatic pediatric arterial injuries.
- To analyze diagnostic and therapeutic strategies employed in managing these injuries.
- To assess the prognostic capability of the MESS in predicting limb salvage outcomes.
Main Methods:
- Retrospective analysis of 44 pediatric patients (aged 9.0 +/- 3.2 years) treated for extremity arterial lesions.
- Data collected included demographics, injury mechanisms, lesion severity (Vollmar, MESS), diagnostic/therapeutic management, complications, and outcomes.
- Exclusion criteria included age > 14, venous, and iatrogenic vascular injuries.
Main Results:
- Femoral artery (25%) and brachial artery (22.7%) were most frequently injured.
- Injury mechanisms included penetrating trauma (31.8%), blunt trauma (29.6%), multiple trauma (25%), and supracondylar fractures (13.6%).
- A MESS score < 7 correlated with successful initial (p < 0.05) and definitive lower extremity limb salvage (p < 0.001).
Conclusions:
- Traumatic pediatric vascular injuries are rare, often resulting from penetrating trauma or extremity fractures in isolated or polytrauma cases.
- The MESS can serve as a valuable tool for guiding limb salvage versus amputation decisions in pediatric patients.
- Effective management requires understanding injury patterns and utilizing appropriate diagnostic and surgical interventions.
Background:
Traumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS) was evaluated.
Methods:
In a retrospective clinical study 44 children aged 9.0 +/- 3.2 years treated for traumatic extremity arterial lesions in our Level I trauma center between 1971 and 2006 were enrolled. Exclusion criteria were age > 14, venous and iatrogenic vascular injury. Demographic data, mechanism of injury, severity of arterial lesions (by Vollmar and MESS), diagnostic and therapeutic management, complications and outcome were evaluated.
Results:
The most commonly injured vessel was the femoral artery (25%) followed by the brachial artery (22.7%). The mechanism of injury was penetrating (31.8%), isolated severe blunt extremity trauma (29.6%), multiple trauma (25%) and humeral supracondylar fractures (13.6%). In 63.6% no specific vascular diagnostic procedure was performed in favour of emergency surgery. Surgical reconstructive strategies were preferred (68.2%). A MESS < 7 was associated with initial (p < 0.05) and definite limb salvage (p < 0.001) of the lower extremity.
Conclusions:
Traumatic paediatric vascular injuries are very rare. The most common situations of vascular lesions in childhood were penetrating injuries and fractures of the extremities either as isolated injuries or in multiply injured patients. In paediatric patients, the MESS could serve as a basis for decision making for limb salvage or amputation.
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