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Penetrating extremity trauma

Roy Danks roydanks at hotmail.com
Fri Apr 21 14:27:01 BST 2006


ABI of > 0.8??!!!  That's not standard thinking in vascular surgery, last I knew.

ABI of <0.95 is considered abnormal.  This, to me, indicates you must at least image the vessel.  
Doesn't mean you have to do anything, as evidenced by this paper:  

Validation of Nonoperative Management of Occult Vascular Injuries and Accuracy of Physical Examination Alone in Penetrating Extremity Trauma: 5- to 10-Year Follow-up. 
Journal of Trauma-Injury Infection & Critical Care. 44(2):243-253, February 1998.
Dennis, James W. MD, FACS; Frykberg, Eric R. MD, FACS; Veldenz, Henry C. MD, FACS; Huffman, Susan BA; Menawat, Sunil S. MD 

So, Ron, if you feel an ABI of 0.85 is "OK", then why bother trying to "figure out which nerve is affected"?  You're obviously
not interested in repairing the potential arterial injury and you can't do much with a severed nerve (within limits and reason)...
so, why bother?  Medicolegal?  If that's the case, I suggest you review the vascular literature.  We image those with ABIs <0.95 who have PVD.

Any other thoughts out there?

RD

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