TREATMENT OF VASCULAR-LESIONS ASSOCIATED WITH OPEN FRACTURES

Vascular injuries associated with open fractures occur rarely, in about 1 % of the cases. Brachial and popliteal arteries are the most exposed vessels in combination with humeral, femoral and tibial fractures. Vascular lesions are first diagnosed clinically: hard signs of arterial trauma (for instance, a pulseless extremity) certainly indicate the injury. Soft signs (for instance, a wound adjacent to a great vessel) only suggest the vascular trauma. Doppler signal allows to distinguish an ischemic extremity from a member still perfused by collaterals. Preoperative arteriography is indicated in patients presenting with soft signs of arterial injury. It is also indicated in patients with hard signs when further information can help the plan of reconstruction. Fracture stabilization is generally carried out before vascular repair. Arteries are prepared in healthy segments and, in most cases, a venous bypass is performerd. Veins proximal to the tibial trifurcation are sutured. Specific differences between upper and lower limb in the evaluation and treatment of vascular injuries associated with open fractures are mentioned.