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Penetrating extremity trauma

Ronald Gross Rgross at harthosp.org
Fri Apr 21 14:36:04 BST 2006


Hmmmm - so it is written, so it is done?
We are talking stab wounds here. 
And my radiologists already have more cars then they have the time to
drive......

>>> roydanks at hotmail.com 04/21 9:27 AM >>>
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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