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Outcomes of arterial vascular extremity trauma in pediatric patients
Mary Kirkilas1, David M Notrica2, Crystal S Langlais3
1Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016.
Insights
Pediatric vascular trauma, often from penetrating injuries, requires timely revascularization. While survival is high, impaired function is a common complication, necessitating further surgical interventions.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Trauma Care
Background:
- Vascular trauma in children is rare but poses significant repair challenges.
- This study reports outcomes of pediatric extremity vascular trauma from a single trauma center.
Purpose of the Study:
- To analyze the characteristics and outcomes of acute, non-iatrogenic traumatic arterial vascular injuries in pediatric patients.
- To evaluate surgical management and complication rates in this cohort.
Main Methods:
- Retrospective chart review of patients under 18 with extremity vascular trauma (Jan 2008-Dec 2013).
- Data abstracted included demographics, injury details, surgical interventions, and patient disposition.
- Nonparametric statistical methods were used for comparison.
Main Results:
- 23 children (median age 8 years, 61% male) with 100% survival.
- Penetrating injuries (74%) were the main cause, with a median presentation time of 154 minutes.
- Primary repair (65%) or vein grafts (30%) were used for revascularization; 13% required fasciotomies and 13% underwent amputation.
- Upper extremity injuries (65%) were more common; impaired function was the most frequent complication (60% short-term, 75% long-term).
Conclusions:
- Pediatric vascular trauma is linked to penetrating injuries, male gender, and upper extremity involvement.
- High patency rates (87%) were achieved with revascularization, but multiple surgeries are often needed.
- Despite no mortality, impaired function is a significant complication, though good outcomes are achievable with timely intervention.
Background:
Vascular trauma in children, although rare, carries significant risk for repair. Here we report outcomes from a single trauma center for children with extremity vascular trauma, proximal to the digits.
Methods:
Retrospective chart review of patients less than age 18years with an acute, non-iatrogenic traumatic arterial vascular injury of the upper and/or lower extremity between January 2008 and December 2013. Abstracted patient demographics, injury characteristics, surgical management, and disposition were summarized and compared with nonparametric methods.
Results:
23 children comprised the study cohort: median age of 8years (IQR: 4.6-12), 61% (n=14) males, 100% survival. Penetrating injuries were the predominate mechanism (n=17, 74%). The median time to presentation was 154min (IQR: 65-330). Acute operations for revascularization included a primary repair (n=15, 65%) or reversed vein graft (n=7, 30%). Fasciotomies were done for 3 (13%) patients. Three amputations were done for failed revascularization. Upper extremity vascular injury (n=15, 65%) was more common. The rate of associated extremity fracture was similar between upper (21%) and lower (33%) extremities (p=0.643). Eight (35%) patients required additional surgery most commonly for debridement, washouts and dressing changes. Three patients' hospital stays were complicated by infection. Impaired function was the most common short- and long-term complication (60%, 75%).
Conclusion:
Pediatric vascular injuries are commonly associated with penetrating injuries and male gender and occurred more frequently in the upper extremities. Overall patency rates after repair were 87%. Fasciotomies were done in 13% of patients, and the overall surgical amputation rate was 13%. There was no mortality in this cohort; however, multiple operations are commonly required, including the return to OR for washouts, debridements and dressing changes. The most common short- and long-term complication was impaired function. Overall good results are achievable in pediatric vascular trauma treated with revascularization.
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