TY  - JOUR
PY  - 2016//
TI  - Outcomes of arterial vascular extremity trauma in pediatric patients
JO  - Journal of pediatric surgery
A1  - Kirkilas, Mary
A1  - Notrica, David M.
A1  - Langlais, Crystal S.
A1  - Muenzer, Jared T.
A1  - Zoldos, Jozef
A1  - Graziano, Kathleen
SP  - 1885
EP  - 1890
VL  - 51
IS  - 11
N2  - BACKGROUND: Vascular trauma in children, although rare, carries significant risk for repair. Here we report outcomes from a single trauma center for children with extremity vascular trauma, proximal to the digits. <br><br>METHODS: Retrospective chart review of patients less than age 18years with an acute, non-iatrogenic traumatic arterial vascular injury of the upper and/or lower extremity between January 2008 and December 2013. Abstracted patient demographics, injury characteristics, surgical management, and disposition were summarized and compared with nonparametric methods. <br><br>RESULTS: 23 children comprised the study cohort: median age of 8years (IQR: 4.6-12), 61% (n=14) males, 100% survival. Penetrating injuries were the predominate mechanism (n=17, 74%). The median time to presentation was 154min (IQR: 65-330). Acute operations for revascularization included a primary repair (n=15, 65%) or reversed vein graft (n=7, 30%). Fasciotomies were done for 3 (13%) patients. Three amputations were done for failed revascularization. Upper extremity vascular injury (n=15, 65%) was more common. The rate of associated extremity fracture was similar between upper (21%) and lower (33%) extremities (p=0.643). Eight (35%) patients required additional surgery most commonly for debridement, washouts and dressing changes. Three patients' hospital stays were complicated by infection. Impaired function was the most common short- and long-term complication (60%, 75%). <br><br>CONCLUSION: Pediatric vascular injuries are commonly associated with penetrating injuries and male gender and occurred more frequently in the upper extremities. Overall patency rates after repair were 87%. Fasciotomies were done in 13% of patients, and the overall surgical amputation rate was 13%. There was no mortality in this cohort; however, multiple operations are commonly required, including the return to OR for washouts, debridements and dressing changes. The most common short- and long-term complication was impaired function. Overall good results are achievable in pediatric vascular trauma treated with revascularization.<br><br>Copyright © 2016 Elsevier Inc. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0022-3468
UR  - http://dx.doi.org/10.1016/j.jpedsurg.2016.07.001
ID  - ref1
ER  -