Download
1 / 24
240 likes | 245 Views
This article discusses the numbers and management of vascular injuries during the Great March of Return, highlighting the challenges faced in Gaza and providing recommendations for improvement.
E N D
Vascular Injuries during the Great March of Return: Numbers and Management Dr. Ismail Aljadba Head of Vascular Surgery Department - SMC
background • Vascular trauma can pose a threat to both the affected limb as well as life of the patient. • Concomitant injuries and prolonged ischemia are the major causes of lower extremity morbidity and poor rates of limb salvage.
background • These patients are highly susceptible for amputation due to the high-velocity close-range gunshots. • In addition to critical vascular and nerve injury and the presence of huge row area and crushed muscles. • These patients are prone to further injury complications such as; compartment syndrome, infection, DVT and vascular rupture.
We documented, site of injury and management of 306 patients with various vascular injuries during the 20 successive Fridays of the Great March or Return, from the 30th March up to the 10th Aug 2018.
Vascular Injuries at Shifa Medical Complex: The total number of vascular injuries is 306. They are distributed as follows:
Vascular Injury According to the Site: • Lower Limb constituted 93.1% (285 Cases) of all surgeries. • Upper Limb, chest, abdomen and pelvic constituted the rest (21 cases).
Management • The management of vascular injuries were as follows: • Vascular reconstruction for all main arteries (Femoral and Popliteal). • In leg injuries, if there was one intact artery, we didn’t perform reconstruction for other two arteries. • If there was a complete arterial injury (3 arteries), we operated the construction for one artery where possible and liberal fasciotomy(four compartments).
management • In regard to venous injury, ligation was the commonest strategy for management. On the other hand, direct suturing and end-to-end anastomosis were in minority of cases. • Interposition graft for venous injury was NOT performed at all.
management • Prophylactic liberal fasciotomy (4 compartments) was done for all venous injury. • In case of pure arterial injury, fasciotomy was operated only if the patient starts to develop compartment syndrome.
management • We didn’t perform temporary intra-arterial shunt nor synthetic grafts except one. • Few skin and muscle flaps were performed to cover the exposed vessels but with no good results. • Closure of the primary wounds or fasciotomies with direct sutures or skin grafts when they are ready.
management • Daily debridement and dressing under general anesthesia. • The average postoperative stay of the cases in the hospital is about 10 days.
Challenges • Poor infrastructure of the hospitals. • Low capacity to absorb repeated influxes of tens of causalities every week in terms of available beds (either in ED or OR or the departments). • Shortage of medical supplies, medicines and surgical instruments due to the imposed blockade on Gaza.
Lack of enough vascular surgeons to meet the huge number of vascular injuries. • Overload on the available vascular surgeons which exhaust the whole team with continuous and intolerable situation. • Lack of delegations to help in containing the disaster.
Except the Jordanian delegation who came to Gaza and our colleagues from WB and Jerusalem, who came to Gaza during the most difficult days to help and support the surgical teams in Shifa hospital. • Inability to refer cases outside Gaza to release the load or to receive more needed advanced management.
Recommendations • To provide Gaza hospitals with the needed Medical supplies, medicines and Instruments. • Improve the infrastructure of hospitals to increase the beds. • Provides advanced Training to the vascular surgeons from Gaza and specialization in vascular surgery for juniors.
conclusion • We conclude that prophylactic fasciotomy is of great importance in reducing the numbers of amputation among injured patients. • Over 3 wars on Gaza, this addresses the sensational experience of vascular surgeons. • The fabulous coordination and cooperation among medical staff at borders (stabilization medical points), transfer facilities and vascular surgeons. This leads to quick and feasible management of injured patients.
conclusion • The lessons applicable to vascular trauma in our current situation can be illustrated from our series. • All vascular trauma and the repair of these injuries have an acceptable mortality rate. • Vascular repair does not completely prevent amputations, but it may prevent a level of amputation, translating to a more functional limb.
conclusion • Our results confirm the brutality of Israeli army against demonstrators in the great return peaceful March. It also re-affirmed the fact that the Israeli snipers intended to target the lower extremities to cause a permanent disability among protesters. • The resilience of the staff in the hospitals and the health system supports the avoidance of having a health disaster in Gaza.
