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외상성 사지동맥 손상의 수술후 추적관찰 결과: 심한 개방성 골절을 동반한 외상을 중심으로
김영욱,정한준 대한혈관외과학회 1997 Vascular Specialist International Vol.13 No.1
Complex vascular and orthopedic injury of the extremity is one of the challenging tasks in current trauma surgery. Every efforts for limb salvage may result in chronic disability or even limb loss. There is no established indications for the limb salvage procedure for the patients with severe, complex injuries of the extremity which has neurovascular and orthopedic injuries. The purpose of this study is directed to establish optimal management plan for the patients with severe complex vascular injuries in extremity by reviewing our results of vascular reconstructive surgery for them. During the period from January, 1994 to January, 1997, 43 extremities with vascular injuries in 42 patients who underwent vascular reconstrcutions were included. The vascular injuries involved the arteries in 16 upper and 27 lower extremities. The clinical presentations were ischemia in 15, ischemia and bleeding in 13, massive bleeding in 7, false aneurysm in 5, and arteriovenous fistula in 3 limbs. Combined extremity injuries with the arterial injuries were 22 extremity bone fractures, 16 soft tissue losses, 13 nerve injuries, 12 deep venous injuries, and 3 joint dislocations. Among the 43 arterial injuries, 12 limbs had open fractures of extremity bones and nerve, musculotendinous, and associated venous injuries requiring replantation procedures. With the arterial reconstructions including 27 interposition grafts(26 veins and 1 PTFE graft), 11 arteriorrhaphies, 3 end-to-end anastomosis, and arterial ligation and 1 vein patch grafting, venous reconstructions using interposition vein grafts were performed in 12 limbs. Postoperative limb amputations were required in 3 lower and 2 upper extremities. The causes of postoperative limb losses were soft tissue infections in lower extremities and vascular complications in upper extremities. Follow-up examinations for the salvaged limbs were made in 31 limbs(12 upper extremities, 19 lower extremities) during the mean period of 17.8 months(1 - 36 months). Five(41.7%) upper limbs revealed motor paralysis and 2(10.5%) lower limbs were unable to bear weight. After vascular reconstructions for the extremity arterial injuies, the causes of limb loss showed to be different between the upper and lower limbs. After considering the limb function and patients emotional satisfaction, our current recommendations for the management of extremity arterial injury are directed to an aggressive vascular reconstruction for upper extremity injury to preserve even the functionless hand and a selective vascular reconstruction should be performed for lower extremity injury after an evaluation of combined soft tissue injury and/or contamination.
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비침습적 검사를 이용한 수술후 하지 심부 정맥 혈전증의 감시
김영욱,정한준,윤봉호,김신윤,이상국,변경환,김태헌 경북대학교 병원 1997 경북대학교병원의학연구소논문집 Vol.1 No.1
Deep vein thrombosis is recognized as a common complication in surgical patients in western countries especially in patients with high risk factors. The purposes of this study were to detect leg DVTs in early postoperative period by non-invasive surveillance and to analyze the risk factors of DVT. One hundred seventy one patients who underwent major operations(67 curative resection of colorectal cancer, 64 total hip replacement, 38 femur operation for fracture, and 2 colon resections for benign colon disease) were included for the prospective surveillance of leg DVT within 2 weeks after the operations. For the surveillance of leg DVT, strain gauge plethysmography(SPG) and Duplex scanning of both legs were completed for all patients except 10 patients. These 10 patients were examined in only one leg. The patients with past history of leg DVT or under prophylactic anticoagulant therapy were excluded from this study. To determine the risk factors related with leg DVT formation, age and sex of the patients, indication of surgery or surgical procedures, duration of operation, position during the operation, duration of postoperative immobilization, and preoperative serum level of antithrombin III (AT- III) were analyzed using Chi-square test. After performing SPG of 342 legs, 38 legs, showed abnormal on venous outflow/venous capacitance discriminant line chart, and 13 legs of 12 patients showed the finding(s) suggesting DVT on duplex scanning. Among the patients with abnormal duplex findings, 7 limbs(53.8%) were symptomatic, but the remaining 6 legs were silent. In 6 (15.8%) patients of 36 femur operations, 3(4.7%) of 64 total hip replacements and 3(4.5%) of 67 curative resections of colorectal cancer developed DVT by duplex scanning in the iliac(5), femoral-popliteal(6), and isolated calf(2) veins. After analyzing the risk factors, we could not find any statistically significant(p<0.05) factor related with leg DVT.
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