The distal part of the vessel routinely underwent thrombectomy with a Fogarty catheter LY3023414 to ensure sufficient backflow. Primary repair or primary anastomosis was practiced
if it was not leading to any narrowing to the injury site or to undue anastomotic tension. If narrowing or tension were pending, a graft was inserted. Although an autologous saphenous vein graft from the contralateral site was our first choice, PTFE (Polytetrafluoroethylene) graft was used if the saphenous vein was unavailable, of the vein was of insufficient diameter or if the time needed to harvest the vein would be detrimental to the patient’s outcome. Whenever graft was used, great care was taken to cover it with viable muscle or other well perfused soft tissues available. In most cases venous injuries were dealt with by ligation. In cases of injury of large diameter veins which could be repaired by simple suturing, ligation could be BI 2536 in vitro avoided. We never attempted to repair any venous injuries by complex
techniques, such as fashioning of a spiral graft. In all cases venous repair preceded the arterial one. In cases of skeletal injury accompanied by significant bone instability or length shortening, distal revascularisation was initially achieved by the use of a temporary arterial shunt. In these cases, mTOR inhibitor skeletal fixation followed immediately, as did removal of the temporary shunt and replacement of it by a vein or PTFE graft. Temporary shunting (Figure 2) also was used in cases of physiologically instability of the patient which enforced postponement of definitive management of the injured (damage
control situations; pending or obvious DIC). Figure 2 Temporary shunting of the femoral artery. Early fasciotomy was performed in the presence of distal swelling, severe distal muscular- skeletal injury, delayed restoration of blood flow (more than 4 to 6 hours after accident/injury) and venous ligation. There was a tendency to perform fasciotomy in any doubtful cases or in the presence of an anticipated fantofarone reperfusion injury . Compartment syndrome was clinically diagnosed and at no stage intra-compartmental pressures were measured. Nerve injury was repaired at the time of the arterial repair only if the patient was haemodynamically stable and the repair of the nerve was considered technically easy . Methodologywise, in three patients with bilateral femoral arterial injury (with side different treatment and outcome), each side was treated, analyzed and counted as a single injury. Results There were a total of 113 patients who underwent operation for 116 penetrating arterial injury to the limbs. There were 103 male and 10 female patients. The mean age was 25 years (range 13–66 years). Of these 113 patients, 61 had received gunshot wounds and 30 received stab knife wounds. 20 injuries were inflicted by other sharp instruments and in two patients injury was related to dog bites.