The incidence of acute venous injury as a result of proximity penetrating trauma screened with colour flow duplex ultrasound
Journal
Injury
Journal Volume
45
Journal Issue
1
Pages
192
Date Issued
2014
Author(s)
Mollberg, N.M.
Wise, S.R.
Keyashian, B.
Ver, M.R.
Sullivan, R.
Holevar, M.
Vafa, A.
Clark, E.
Merlotti, G.J.
Abstract
Introduction: The incidence of acute deep venous thrombosis as a result of penetrating proximity extremity trauma (PPET) to the thigh has been demonstrated to be 16% in a single report. The purpose of the current study is to demonstrate the incidence and clinical significance of venous injury as a result of proximity trauma to the thigh in a large cohort screened with colour flow duplex (CFD) ultrasound and to identify factors predictive of defining a wound in proximity to a major vascular structure. Patients and methods: A prospective observational study was conducted from January 1st, 2010 to January 1st, 2012 on all patients presenting with penetrating extremity trauma. Data on injury location, mechanism, associated extremity and non-extremity injuries, use and results of CFD, as well as the admitting trauma surgeon were recorded and analysed. Results: 220 thigh wounds with a normal physical examination were identified, of which 167 (75.9%) underwent CFD due to proximity. The incidence of acute venous injury was 4.8% (8/167). 37.5% (3/8) of these injuries resulted in morbidity. Injury mechanism and which attending physician was on call were predictive of a wound being defined as in proximity, whereas an injury with an associated fracture was a negative predictor. Conclusions: Occult venous injuries as a result of PPET occur in 4.8% of patients with thigh wounds in proximity to a major vascular structure. The designation of a wound as being in "proximity" was influenced by injury mechanism, associated fractures, and the judgement of the on-call attending. Colour flow duplex is a valuable tool with the ability to identify not only occult arterial injuries, but also venous injuries with the potential to cause significant morbidity as well. © 2012 Elsevier Ltd.
Subjects
Colour flow duplex; Proximity; Venous; Extremity; Screening
SDGs
Publisher
ELSEVIER SCI LTD
Type
journal article