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Penetrating extremity trauma

docrickfry at aol.com docrickfry at aol.com
Fri Apr 21 17:53:42 BST 2006

I would do what we have routinely done for many years, with the results as published extensively over the past 17 years
I would send both patients home, and without any ABI being done.  
And this is not just me--every institution and paper that has studied this issue by comparing angio findings with physical findings and nonop observation of all proximity wounds, comes to the same conclusion, amounting to almost 4000 published cases of asymptomatic penetrating proximity extermity injuries in the literature, and confirmed with our 5-10 year followup paper, none have ever shown otherwise--for the raw data see Table 43-7, page 980 in Moore, Mattox and Feliciano's 5th edition of TRAUMA.  The missed injury rate of physical exam for surgically significant vascular injuries is the same as that for angio--less than 1%, with not a single missed injury using this approach in this setting ever yet once having been reported to result in any limb morbidity or loss. 
There are few issues in all of medicine with such compelling data in support of an approach, and such a dearth of data refuting it.
-----Original Message-----
From: Roy Danks <roydanks at hotmail.com>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Fri, 21 Apr 2006 11:20:35 -0500
Subject: RE: Re: Penetrating extremity trauma

This topic is going in circles.  ERF just restated what I stated earlier.  You 
assess them all the same way.
SW, GSW, SGW, Fx, etc.  Do the physical exam.

So, ERF let me ask you what you would do with these patients:

25 y.o., SW, Medial thigh.  No "hard signs", but ABI of 0.85.  

Same patient, SW Lateral thigh.  No "hard signs", but ABI of 0.85.

I'm a general surgeon in rural Missouri.  I can shoot an arteriogram, get a 
Doppler and I am proficient in carotid endartarectomies and fem-pops.

What should I do?

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