The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study
Introduction: There is no consensus yet whether delayed limb salvage procedures with an “ischemic time” of more than 6 hours are worthwhile, as these repairs are often complicated by reperfusion injury. Our study aims to determine the outcomes of delayed revascularization to validate our current tre...
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Malaysian Orthopaedic Association
2025-03-01
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| Series: | Malaysian Orthopaedic Journal |
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| Online Access: | https://www.morthoj.org/2025/v19n1/vascular-injury.pdf |
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| author | Chai KS Faisham WI Wan-Sulaiman WA Rosli MA Mat-Saad AZ Jusoh MH Paiman M Halim AS |
| author_facet | Chai KS Faisham WI Wan-Sulaiman WA Rosli MA Mat-Saad AZ Jusoh MH Paiman M Halim AS |
| author_sort | Chai KS |
| collection | DOAJ |
| description | Introduction: There is no consensus yet whether delayed limb salvage procedures with an “ischemic time” of more than 6 hours are worthwhile, as these repairs are often complicated by reperfusion injury. Our study aims to determine the outcomes of delayed revascularization to validate our current treatment approach and assess areas for future improvement.
Materials and methods: We performed a retrospective cohort study on a highly selected group of patients who underwent delayed revascularization surgery for lower extremity traumatic vascular injuries in our institution from January 2008 to June 2018. Exclusion criteria include the presence of a terminal non-salvageable ischemic limb; defined as a gangrenous extremity evident by non-blanchable, mottled skin with complete limb paralysis, renal trauma, known renal impairment, and those with an ischemic time less than 6 hours. The demographic data, type and level of vascular, type of injuries, duration of ischemia, MESS score, and the need for secondary amputation were assessed.
Result: Fifty-nine patients were identified and included in the analysis. Fifty patients (84.7%) were male, while 9 patients (15.3%) were female. The mean age was 28.1 years. The most injured vessel was the popliteal artery (n=41, 69.5%). The commonest injury pattern was contusion with thrombosis (n=31, 52.5%). Revascularizations were mainly achieved by interposition saphenous vein graft (n=40, 67.8%). The mean duration of delayed was 14.1 hours. A total of 83.1% of patients (n=49) had a Mangled Extremity Severity Scoring (MESS) of 7 and above. The limb salvage rate in this study was 89.8%, with only 6 patients (12.2%) requiring secondary amputations. Thirty-one patients developed rhabdomyolysis, with 6 cases (19.4%) requiring temporary inpatient renal replacement therapy (RRT). Out of the six, only one patient required lifelong RRT.
Conclusions: Limb salvage in those with the duration of delayed of more than 6 hours should be attempted after careful assessment and a high rate of limb salvage, minimal renal complication and acceptable functional (mobility) outcomes can be achieved, despite the reperfusion injury that accompanies.
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| format | Article |
| id | doaj-art-3cb8dd2094b643b6917829ff98f79b45 |
| institution | DOAJ |
| issn | 1985-2533 2232-111X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Malaysian Orthopaedic Association |
| record_format | Article |
| series | Malaysian Orthopaedic Journal |
| spelling | doaj-art-3cb8dd2094b643b6917829ff98f79b452025-08-20T03:17:02ZengMalaysian Orthopaedic AssociationMalaysian Orthopaedic Journal1985-25332232-111X2025-03-011911910.5704/MOJ.2503.008The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort StudyChai KS0Faisham WI1 Wan-Sulaiman WA2 Rosli MA3Mat-Saad AZ4 Jusoh MH5Paiman M6 Halim AS7Reconstructive Sciences Unit, Universiti Sains Malaysia, Kubang Kerian, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaReconstructive Sciences Unit, Universiti Sains Malaysia, Kubang Kerian, MalaysiaReconstructive Sciences Unit, Universiti Sains Malaysia, Kubang Kerian, MalaysiaReconstructive Sciences Unit, Universiti Sains Malaysia, Kubang Kerian, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaReconstructive Sciences Unit, Universiti Sains Malaysia, Kubang Kerian, MalaysiaIntroduction: There is no consensus yet whether delayed limb salvage procedures with an “ischemic time” of more than 6 hours are worthwhile, as these repairs are often complicated by reperfusion injury. Our study aims to determine the outcomes of delayed revascularization to validate our current treatment approach and assess areas for future improvement. Materials and methods: We performed a retrospective cohort study on a highly selected group of patients who underwent delayed revascularization surgery for lower extremity traumatic vascular injuries in our institution from January 2008 to June 2018. Exclusion criteria include the presence of a terminal non-salvageable ischemic limb; defined as a gangrenous extremity evident by non-blanchable, mottled skin with complete limb paralysis, renal trauma, known renal impairment, and those with an ischemic time less than 6 hours. The demographic data, type and level of vascular, type of injuries, duration of ischemia, MESS score, and the need for secondary amputation were assessed. Result: Fifty-nine patients were identified and included in the analysis. Fifty patients (84.7%) were male, while 9 patients (15.3%) were female. The mean age was 28.1 years. The most injured vessel was the popliteal artery (n=41, 69.5%). The commonest injury pattern was contusion with thrombosis (n=31, 52.5%). Revascularizations were mainly achieved by interposition saphenous vein graft (n=40, 67.8%). The mean duration of delayed was 14.1 hours. A total of 83.1% of patients (n=49) had a Mangled Extremity Severity Scoring (MESS) of 7 and above. The limb salvage rate in this study was 89.8%, with only 6 patients (12.2%) requiring secondary amputations. Thirty-one patients developed rhabdomyolysis, with 6 cases (19.4%) requiring temporary inpatient renal replacement therapy (RRT). Out of the six, only one patient required lifelong RRT. Conclusions: Limb salvage in those with the duration of delayed of more than 6 hours should be attempted after careful assessment and a high rate of limb salvage, minimal renal complication and acceptable functional (mobility) outcomes can be achieved, despite the reperfusion injury that accompanies. https://www.morthoj.org/2025/v19n1/vascular-injury.pdfvascular system injurieslower extremityrhabdomyolysisrenal dialysisamputation |
| spellingShingle | Chai KS Faisham WI Wan-Sulaiman WA Rosli MA Mat-Saad AZ Jusoh MH Paiman M Halim AS The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study Malaysian Orthopaedic Journal vascular system injuries lower extremity rhabdomyolysis renal dialysis amputation |
| title | The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study |
| title_full | The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study |
| title_fullStr | The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study |
| title_full_unstemmed | The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study |
| title_short | The Outcomes of Delayed Revascularization in Lower Extremity Vascular Injury: A Retrospective Cohort Study |
| title_sort | outcomes of delayed revascularization in lower extremity vascular injury a retrospective cohort study |
| topic | vascular system injuries lower extremity rhabdomyolysis renal dialysis amputation |
| url | https://www.morthoj.org/2025/v19n1/vascular-injury.pdf |
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