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A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre

Background And Aims: Non-iatrogenic vascular injuries affecting the extremities of children pose a challenge to paediatric surgeons due to their rarity and non-specific presentations. Our aims were to assess the injury profiles, management strategies and short-term outcomes of this condition followi...

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Main Authors: Ab. Rahman, Norhafiza, von Delft, Dirk, Numanoglu, Alp, Mohammad Aidid, Edre, Arnold, Marion
Format: Article
Language:English
Published: 2024
Subjects:
RD Surgery
RD93 Emergency Surgery. Wounds and Injuries
RJ Pediatrics
Online Access:http://irep.iium.edu.my/116724/8/116724_A%2010-year%20analysis%20of%20paediatric%20extremity%20vascular%20injuries.pdf
http://irep.iium.edu.my/116724/
https://mpaeds.my/journals/index.php/MJPCH/issue/view/34
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spelling my.iium.irep.1167242024-12-16T04:01:23Z http://irep.iium.edu.my/116724/ A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre Ab. Rahman, Norhafiza von Delft, Dirk Numanoglu, Alp Mohammad Aidid, Edre Arnold, Marion RD Surgery RD93 Emergency Surgery. Wounds and Injuries RJ Pediatrics Background And Aims: Non-iatrogenic vascular injuries affecting the extremities of children pose a challenge to paediatric surgeons due to their rarity and non-specific presentations. Our aims were to assess the injury profiles, management strategies and short-term outcomes of this condition following paediatric trauma. Methods: A retrospective analysis of the medical records of patients who presented with vascular injuries, focusing on extremity injuries, over 10 years from 2013 to 2022 in our centre in Cape Town, South Africa was conducted. Results: 21 children sustained vascular injuries involving the extremities, affecting 32 vessels (n=22, 68.8% arteries and n=10, 31.2% veins). Males predominated at 76.2% (n=16) with a median age of 11 years and three months and a weight of 30 kg. Road traffic accidents (RTA) were predominant at 47.6% (n=10), followed by firearms at 38.1% (n=8). The femoral artery and popliteal artery were the most frequently injured vessels, accounting for 28.1% (n=9) each. Lower extremity injuries predominated over upper extremity injuries for both arteries (n=20, 90.1%) and veins (n=10, 100%) from our series, and majority (n=31, 96.5%) had surgical interventions. Autologous bypass graft was the most performed procedure at 52.9% (n=9) for the arterial injuries, while for venous injuries, ligation dominated at 85.7% (n=6). Four patients (9.5%) with seven vessels injured underwent primary amputations. All these patients sustained multiple injuries following RTAs, and all four subsequently underwent interventions i.e. amputations within four hours of presentation for haemostasis. Overall, three patients (14.3%), including one who had undergone primary amputation, succumbed to their injuries, all of whom sustained injuries involving femoral arteries. Conclusion: Early major bleeding remains the primary cause of mortality for vascular injuries involving the extremities. Hence, the more proximal the vessel is, the greater the mortality risk. Early diagnosis, resuscitation and prompt intervention, including consideration of damage control measures and/or primary limb amputation when necessary are crucial for reducing mortality rates, prioritizing the principle of saving lives over limbs. 2024-11-21 Article PeerReviewed application/pdf en http://irep.iium.edu.my/116724/8/116724_A%2010-year%20analysis%20of%20paediatric%20extremity%20vascular%20injuries.pdf Ab. Rahman, Norhafiza and von Delft, Dirk and Numanoglu, Alp and Mohammad Aidid, Edre and Arnold, Marion (2024) A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre. Malaysian Journal of Paediatrics and Child Health, 30 (1 (S)). ISSN 1511-4511 https://mpaeds.my/journals/index.php/MJPCH/issue/view/34 10.51407/mjpch.v30i1(S).342
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
topic RD Surgery
RD93 Emergency Surgery. Wounds and Injuries
RJ Pediatrics
spellingShingle RD Surgery
RD93 Emergency Surgery. Wounds and Injuries
RJ Pediatrics
Ab. Rahman, Norhafiza
von Delft, Dirk
Numanoglu, Alp
Mohammad Aidid, Edre
Arnold, Marion
A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre
description Background And Aims: Non-iatrogenic vascular injuries affecting the extremities of children pose a challenge to paediatric surgeons due to their rarity and non-specific presentations. Our aims were to assess the injury profiles, management strategies and short-term outcomes of this condition following paediatric trauma. Methods: A retrospective analysis of the medical records of patients who presented with vascular injuries, focusing on extremity injuries, over 10 years from 2013 to 2022 in our centre in Cape Town, South Africa was conducted. Results: 21 children sustained vascular injuries involving the extremities, affecting 32 vessels (n=22, 68.8% arteries and n=10, 31.2% veins). Males predominated at 76.2% (n=16) with a median age of 11 years and three months and a weight of 30 kg. Road traffic accidents (RTA) were predominant at 47.6% (n=10), followed by firearms at 38.1% (n=8). The femoral artery and popliteal artery were the most frequently injured vessels, accounting for 28.1% (n=9) each. Lower extremity injuries predominated over upper extremity injuries for both arteries (n=20, 90.1%) and veins (n=10, 100%) from our series, and majority (n=31, 96.5%) had surgical interventions. Autologous bypass graft was the most performed procedure at 52.9% (n=9) for the arterial injuries, while for venous injuries, ligation dominated at 85.7% (n=6). Four patients (9.5%) with seven vessels injured underwent primary amputations. All these patients sustained multiple injuries following RTAs, and all four subsequently underwent interventions i.e. amputations within four hours of presentation for haemostasis. Overall, three patients (14.3%), including one who had undergone primary amputation, succumbed to their injuries, all of whom sustained injuries involving femoral arteries. Conclusion: Early major bleeding remains the primary cause of mortality for vascular injuries involving the extremities. Hence, the more proximal the vessel is, the greater the mortality risk. Early diagnosis, resuscitation and prompt intervention, including consideration of damage control measures and/or primary limb amputation when necessary are crucial for reducing mortality rates, prioritizing the principle of saving lives over limbs.
format Article
author Ab. Rahman, Norhafiza
von Delft, Dirk
Numanoglu, Alp
Mohammad Aidid, Edre
Arnold, Marion
author_facet Ab. Rahman, Norhafiza
von Delft, Dirk
Numanoglu, Alp
Mohammad Aidid, Edre
Arnold, Marion
author_sort Ab. Rahman, Norhafiza
title A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre
title_short A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre
title_full A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre
title_fullStr A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre
title_full_unstemmed A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre
title_sort 10-year analysis of paediatric extremity vascular injuries in a tertiary referral centre
publishDate 2024
url http://irep.iium.edu.my/116724/8/116724_A%2010-year%20analysis%20of%20paediatric%20extremity%20vascular%20injuries.pdf
http://irep.iium.edu.my/116724/
https://mpaeds.my/journals/index.php/MJPCH/issue/view/34
_version_ 1818833732530864128
score 13.222552

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