ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ THIẾU MÁU CẤP TÍNH CHI DƯỚI CÓ MỞ CÂN CẲNG CHÂN DO CHẤN THƯƠNG VẾT THƯƠNG TẠI BỆNH VIỆN HỮU NGHỊ VIỆT ĐỨC

Abstract

Objectives: To observe the pathological characteristics and evaluate the outcomes of treatment of acute lower extremity ischemia with fasciotomy due to wound trauma at Viet Duc University Hospital. Method: A retrospective descriptive study with a none control group on 70 patients diagnosed with acute lower extremity ischemia who were revascularized with fasciotomy at Viet Duc University Hospital from January 2020 to December 2021. Result: In 70 studied patients, the male/female ratio = 1.8/1; the average age was 33.2 ± 13.2 years old. The main cause was traffic accidents accounting for 82.9%. Primary healthcare facilities were at the provincial level accounting for 82.9%. The prevalence of vessels damaged by trauma was 94.3%, and by wounds was 5.7%; the majority was popliteal artery accounting for 88.6%. 100% of patients were revascularized at more than 6 hours after the accident. The Rutherford classification IIa or higher accounts for 95.7%. There was no difference between preventative and treatment fasciotomy in males and females (p=0.141 > 0.05, Chi-Square Test). There 17.2% of patients needed to remove necrotic muscle after surgery. 10% had surgical wound bleeding complications; 24.3% had surgical wound inflammation. 5/70 patients with occlusion of the anastomosis required reoperation. 2/70 cases had to be amputated early after surgery due to muscle necrosis unrelated to fasciotomy. There were no cases of acute renal failure or death. The average time of fasciotomy closure is 13.84 ± 6.445 days, the earliest was 4 days, and the latest was 31 days. After 1 month of discharge, 82.4% of patients had limited mobility, 2.9% were immobile; only 48.5% of patients no longer feel pain after surgery. After 6 months, 33.8% of patients had limited mobility, no longer had to be immobile, and the prevalence of pain-free was 97.1%. Conclusion: The outcomes of treatment of acute lower extremity ischemia with fasciotomy due to wound trauma was quite good, influenced by the initial injury characteristics, wound care, and postoperative rehabilitation.