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Penetrating extremity trauma

Ronald Gross Rgross at harthosp.org
Fri Apr 21 15:16:25 BST 2006


Rick,
As usual - you are right, and I stand corrected.
Ron

>>> docrickfry at aol.com 04/21 10:13 AM >>>
Ron--
The diagnostic approach to extremity vascular injury has never been
shown to differ between stabs or gunshots, shotguns, associated
fractures, or in any setting whatever--principles remain the
same---absent hard signs excludes a surgically significant vascular
injury as accurately as any imaging modlaity--postiive hard signs to OR.
 There is no evidence whatever to support anything else, and much to
refute...Yes stabs have lower risk of vascular injury when asymptomatic,
but accuracy of physical findings at predicitng or excluding vascular
injury no different.
ERF 
 
-----Original Message-----
From: Ronald Gross <Rgross at harthosp.org>
To: trauma-list at trauma.org 
Sent: Fri, 21 Apr 2006 09:36:04 -0400
Subject: RE: Re: Penetrating extremity trauma


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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