The major vessels injured with shoulder girdle trauma are the axillary and subclavian arteries. The muscles and bones of the shoulder girdle, which surround these vessels, provide considerable protection against injury. Thus, blunt injuries to the axillary and subclavian arteries…
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Injuries to the carotid arteries are relatively uncommon, but not rare. Despite some variability in reported data from center to center, certain principles have evolved. Injuries to the carotid artery are traditionally considered blunt or penetrating ( Box 1 ).…
Massive bleeding, acute limb ischemia, or a pulsatile hematoma can make the diagnosis of penetrating vascular trauma straightforward, and the first diagnostic procedure is often an appropriate operative exploration. However, the vast majority of vascular injuries arising from penetrating trauma…
The mid-20th century saw the emergence of contrast angiography to clarify and define the extent of vascular wounds. Percutaneous catheter-based angiography began to replace surgical cutdown and needle injection of contrast in the 1950s and 1960s, and became the gold…
Approximately 100,000 to 150,000 persons experience some level of major lower limb amputation in the United States each year. The majority of these patients have diabetes and/or peripheral vascular disease (approximately 90%). A rehabilitation medicine physician (physiatrist) has much to…
Upper extremity amputations are less common than lower extremity amputations in both wartime and civilian settings. During wartime, the incidence of upper extremity amputees is between 13% and 25% of all extremity amputations. A survey of the U.S. National Trauma…
The incidence of major above-knee amputation (AKA) and below-knee amputation (BKA) has been relatively stable over the past few decades, with approximately 60,000 procedures per year performed in the United States. It is not clear that the widespread implementation of…
Amputation is one of the oldest surgical procedures known to humans. The earliest forms of below-knee amputation (BKA) occurred on or near battlefields, where wounded warriors had few alternatives other than to face the surgeon’s knife. Amputations for lower extremity…
The first use of limb amputation was as an implement of punishment or torture. Hippocrates is credited with performing the first amputation for therapeutic purposes. Well into the 20th century, toe or forefoot gangrene was associated with limb loss. Leland…