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Surgical Approach for Vascular Extremiti
- 1. Surgical Approach for VascularExtremities
- 2. â—Ź Kecelakaan LaluLintas Jalan â—Ź Fraktur dan dislokasi â—Ź Senjata â—Ź Sayatan dan tusukan â—Ź Iatrogenik â—Ź Tajam / tembus â—Ź Tumpul Causes
- 3. â—Ź Transection â—Ź Laceration â—ŹContusion â—Ź Kink â—Ź Intimal flap Mechanism of disruption of flow at arterial level
- 4. Signs of avessel injury Hard sign • Active bleeding • Thrills, Bruits • Signs of distal ischaemia • Absent pulse • Pain • Pale • Perishing Cold • Paresthesia / anaesthesia • Paresis / Paralysis • Expanding hematoma
- 5. Signs of avessel injury Soft sign • Hematoma • Injury close to a known neurovascular bundle • Reduced pulse • Paresis / paralysis and paresthesia / anaesthesia - late signs • Paresis and paresthesia • viability of the limb is in immediate threat • Anaethesia and paralysis
- 6. Problems with diagnosingdistal ischaemia after trauma • Pain Bisa karena cedera itu sendiri, mungkin tidak terasa sakit karena cedera saraf yang terkait • Pallor karena kehilangan darah • Absent pulse karena tekanan darah rendah. Bandingkan dengan anggota tubuh lainnya • Paresthesia, paresis Terjadi karena saraf terkait, cedera otot
- 8. Hand held doppler â—ŹAbsent doppler flow â—Ź Quality of signal Duplex scan (uss + doppler) â—Ź Difficult to image in trauma â—Ź Due to - Pain - Non cooperative patient - Dressings Investigations
- 9. Angiography â—Ź CT angiography â—ŹCatheter angiography Investigations
- 10. â—Ź Contrast intoperipheral vein CT ANGIOGRAPHY
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- 13. ● Arteriography On table/ DSA – for multi level injury Investigations
- 14. â—Ź Surgical repair â—ŹPrompt transport to operating room â—Ź General anesthesia â—Ź Cleaning entire limb and be able to visualize the distal end and palpate distal pulses. â—Ź Thigh prepared - for venous harvest â—Ź Mobilisation and control of proximal and distal arterial ends and trimming Treatment
- 15. â—Ź Balloon thrombectomy â—ŹSystemic and distal heparinisation â—Ź Interposition graft / Direct approximation â—Ź Prosthesis - lower patency - infection Surgical repair
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- 17. â—Ź Death â—Ź Limbloss â—Ź Compartment syndrome â—Ź Reperfusion effects â—Ź Volkmann ischemic contracture â—Ź Intimal flaps and narrowing â—Ź False aneurysms â—Ź Traumatic AVF Complications of vascular injury
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- 20. Traumatic Arterio VenousFistula
- 21. â—Ź Revascularization /skeletal fixation (external Fixator - EF) â—Ź Bone fixation first if limb is not threatened â—Ź Revascularisation first if limb is threatened Combined Vascular and Skeletal Trauma
- 22. â—Ź Reduced organperfusion due to increased intra compartment pressure. Causes : â—Ź Trauma (muscle contusion) â—Ź Haematoma â—Ź Reperfusion â—Ź Intracompartmental extravasation of fluids â—Ź Tight bandage, cast Compartment syndrome
- 23. ● Clinical features ●Excessive pain – pain on passive movements of the muscles. ● Numbness -e.g. anterior compartment results in numbness at first toe web i.e. deep peroneal nerve distribution) ● Tense swollen compartment Compartment syndrome
- 24. â—Ź Recognize â—Ź Removethe cause â—Ź Surgery - fasciotomy Compartment syndrome Treatment
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- 26. â—Ź ABCD â—Ź Fasciotomy â—ŹDiscuss â—Ź Transfer In hospitals where facilities for repair is not available
- 27. Local â—Ź Reperfusion injury- paradoxical death of already dying muscles after reperfusion Systemic â—Ź Reperfusion syndrome; â—Ź Hypotension â—Ź ARDS â—Ź Lactic acidosis â—Ź Hyperkalemia â—Ź Renal failure Reperfusion effects
- 28. Management â—Ź Fasciotomy â—Ź Hydration â—ŹMannitol, allopurinol â—Ź 02 â—Ź Inotropes â—Ź Ligation of vessel if not responding to above â—Ź measures Reperfusion effects
- 29. Vascular injury: â—Ź Resuscitate â—ŹAssess viability and extent of injury â—Ź Assess need for fasciotomy â—Ź Early intervention and post intervention monitoring â—Ź Rehabilitation Summary
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- 31. Basic Principles • Incisionplacement • Minimal incisions • Anatomical approach – preoperative assessment • Tissue handling • Careful dissection • Proximal & distal control • Anticoagulation • Precision of technique • Checking
- 32. Incisions & tissuehandling Anatomy preoperative assessment
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- 37. Embolectomy stay Place double endedstay in distal edge
- 38. Rule 1 Rule 2 Rule3 Vascular suturing
- 39. Closure (safe) • Placeall sutures • Interrupted double ended • Tie from corners
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- 41. Closure (large vessel) Continuoussuture = risk of narrowing Large vessels only
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- 45. Vein patch 2 Evertingsuture
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- 47. Suture back fromtoe Alternative: suture around the toe finish on the “near side”
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- 50. End to end(Carrel)
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- 61. End to end– caution!
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- 69. CREDITS: This presentationtemplate was created by Slidesgo, including icons by Flaticon and infographics & images by Freepik Thanks Please keep this slide for attribution