Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

Abstract

BackgroundTraumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS) was evaluated.MethodsIn a retrospective clinical study 44 children aged 9.0 ± 3.2 years treated for traumatic extremity arterial lesions in our Level I trauma center between 1971 and 2006 were enrolled. Exclusion criteria were age > 14, venous and iatrogenic vascular injury. Demographic data, mechanism of injury, severity of arterial lesions (by Vollmar and MESS), diagnostic and therapeutic management, complications and outcome were evaluated.ResultsThe most commonly injured vessel was the femoral artery (25%) followed by the brachial artery (22.7%). The mechanism of injury was penetrating (31.8%), isolated severe blunt extremity trauma (29.6%), multiple trauma (25%) and humeral supracondylar fractures (13.6%). In 63.6% no specific vascular diagnostic procedure was performed in favour of emergency surgery. Surgical reconstructive strategies were preferred (68.2%). A MESS < 7 was associated with initial (p < 0.05) and definite limb salvage (p < 0.001) of the lower extremity.ConclusionsTraumatic paediatric vascular injuries are very rare. The most common situations of vascular lesions in childhood were penetrating injuries and fractures of the extremities either as isolated injuries or in multiply injured patients. In paediatric patients, the MESS could serve as a basis for decision making for limb salvage or amputation.

Difficulties in the Management of Civilian Peripheral Vascular Trauma and their Complications at the University Teaching Hospital of Yaoundé, Cameroon

“…This is consistent with literature data where penetrating injuries represent more than 2/3 of injuries in the limbs [1][2][3]. Mommsen et al [6], however, found penetrating wounds in only 31.8% of cases and Jawas et al [7] reported stab lesions in 57% of cases. These findings in our series, although in the line with that of many authors, could be explained by the increase in criminality in our country associated to an increase use of firearms (4 cases) and bladed weapons (8 cases).…”

“…Male predominance due to the predominance of trauma in general in men compared to women is the same as in the literature [1][2][3][4][5][6][7][8]. The young age of our patients is also found in several studies.…”

“…These findings in our series, although in the line with that of many authors, could be explained by the increase in criminality in our country associated to an increase use of firearms (4 cases) and bladed weapons (8 cases). There is a preponderance of the lower limb lesions as reported in the literature [2,6,7,9,10]. We have found only 3 cases associated with bone and nerve lesions.…”

“…If endovascular techniques (embolization, stenting) are widely used in the Western world for some vascular injuries [18], open surgery keeps a place of choice for many authors with good results [6][7][8][9]. However, endovascular techniques in properly selected patients offer many advantages.…”

Peculiarities of the diagnosis and treatment of arterial trauma in children

“…Зупинка артеріальних кровотеч та реваскуляризації в подальшому ще не гарантують по-вного одужання через стенозування чи оклюзії судин-них анастомозів та дилатацію автовенозних протезів [9,11,18,29,49]. Зауважимо, що загальноприйнятих протоколів лікування травм артерій у дітей на сьогодні немає [1,8,22,27,36,38,46,49].…”