Date: Fri, 24 Jan 2003 09:00:41 -0500

Subject: Combined Vasular/Skeletal Injury Repair Sequence

Case 1 - comminuted open supracondylar fx femur, no pulses, huge hematoma and bleeding. The angio shows popliteal artery transection. Immediately taken to OR where proximal and distal control are obtained prior to shunting. THEN Ortho ex-fixes the joint. The artery is definitively repaired. The wound is debrided. Later Ortho does a definitive ORIF with bone graft - successful.

Click Images to zoom in.

Initial Angio	Transection Injury	Shunt

Case 2 - avulsed elbow joint with complete pulling apart of brachial artery, open wound with huge overlying skin loss. Immediate OR, brachial artery shunted, THEN Ortho puts on cross-joint ex-fix, we come back and definitively repair artery (ASVG), document patency with on table completion angio--then plastics swings lat dorsi pedicled flap thru axilla to cover.

Click Images to zoom in.

Initial xray	Shunt then ex-fix	Vascular repair	Completion angio

These cases make the point that revascularization (whether by definitive repair or shunt, no matter -) ALWAYS takes precedence - revascularization should NOT EVER be delayed in favor of skeleton stabilzation.

References

Eric Frykberg, MD
UF Jacksonville