Trauma and vascular injuries.

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Road side accidents are common in the metropolitan cities and rural areas. When some one is injured our first concern is blood loss due to vascular injuries. when the fractures occur in the extremities especially after motor bike accidents the arteries are going to be crushed above, behind and below the knee close to the site of fractures. In such cases the blood supply to the legs is reduced or absent. The tissues in the foot can not withstand the diminished blood supply for longer than few hours. In the absence of blood supply tissues will suffer which is known as the "Ischemic damage". So, the orthopedicians ( trauma surgeons) always look and palpate the feet to feel pulses in the foot. If the pulse are not felt in the foot after an accident it is important to suspect injury to the leg arteries. Then one would ask for tests to know the site of vascular injury. These tests are Doppler tests and angiogram. These tests will show the site of the blood damage and blood clots in the damaged blood vessels. One repair the blood vessels, replace them or remove the blood clots to re-establish the blood supply to the leg as before. If the circulation can not be established it can result in gangrene of the leg. If the injury is severe then it may not possible to repair the blood vessels. These days the technical skills have also improved and results are getting better. But the extensive damage to the muscles due to the crush injury may not result in viable leg even after the repair of the blood vessels. Repair of the blood vessels and re-establishment of circulation can also result in re-perfusion injury and muscle necrosis if there was long gap between the injury and repair. In our country, there is a need to improve the awareness of these therapies for vascular injuries along with road side accidents, fractures and the we need to stress the importance of early detection

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