TEXTBOOK READING
Disusun oleh :
Pembimbing Klinik:
dr. Minidian Fasitasari, Sp.GK
Izam Arif Hidayat (3010190108)
VASCULAR TRAUMA
Anatomi Vaskular
Epidemiologi
• Terjadi 1-2% dari seluruh trauma
• Menyebabkan 30% amputasi ekstremitas pasca trauma
• Menyebabkan 20% kematian akibat trauma
• 50% terjadi pada ekstremitas
Huber GH, Manna B. 2020. Vascular Extremity Trauma, StatPearls Publishing:2020 Jan
Perler B, Rutherford, R. and Sidawy, A.2019. Rutherford’s vascular surgery and endovascular theraphy, 9th ed.Philadelphia, PA: Elsevier
Database Departemen Bedah Thorax, Kardiak, dan Vaskular, dan Instalasi Gawat Darurat RSUD Dr. Soetomo pada tahun 2019-2020
mekanisme
Tembus - Crushing
- Separasi jaringan sepanjang
perjalanan benda yang mempenetrasi
Tumpul
- Kompresi local;
- Deselerasi cepat; &
- Mengakibatkan gaya robekan
Bietz GJ and Bobadilla JL. Overview of Vascular Trauma, In: Dua A, Desai SS, Holcomb JB, Burgess AR and Freischlag JA (eds). Clinical Review of Vascular Trauma, Berlin, Heidelberg: Springer Berlin Heidelberg, 2014, p.3-20
Perler B, Rutherford, R. and Sidawy, A.2019. Rutherford’s vascular surgery and endovascular theraphy, 9th ed.Philadelphia, PA: Elsevier
Trauma Tumpul vs Trauma Tembus
Perler B, Rutherford, R. and Sidawy, A.2019. Rutherford’s vascular surgery and endovascular theraphy, 9th ed.Philadelphia, PA: Elsevier
Tahalele P, Basuki S, Puruhito. Penelitian Trauma Vaskular Selama 7 Tahun di Surabaya, Buletin Toraks Kardiovaskular Indonesia 1993; volume 1(2):5
Types of Vessel Injury
• Mostly: laceration or transection
• Incomplete transection (Mattox 2000):
Mild: <25%
Moderate: 25-50%
Severe: >50%
Pathofisiologi
Vascular Trauma
Perdarahan
Syok Perdarahan
Konsumtif Koagulopati
Iskemia Jaringan
Distal
Reperfusion Injury
Syndoma Compartment
Necrosis
Feliciano DV, 2002, Management of Peripheral Vascular Trauma, American College of Surgeons Committee on Trauma
Shackford SR, 2020, Peripheral Vessels, Trauma, 9th edition, MCGRAW HILL EDUCATION, Pp. 919-939
KLASIFI KASI TRAUM
A
ARTERI
Hard Signs
• Pulsatile bleeding
• Expanding hematoma
• Palpable thrill
• Audible bruit
• Evidence of regional ischemia:
Pallor
Paresthesia
Paralysis
Pain
Pulselessness
Poikilothermia
Soft Signs
• History of moderate hemorrhage
• Injury (fracture, dislocation, or penetrating wound) in proximity to major artery
• Diminished but palpable pulse
• Peripheral nerve deficit
Pemeriksaan Penunjang
USG
CT
CT
Arteriography
• Negative predictive value 99-100%
• Sensitivity 97-100%
• Specificity 90-98%
• Accuracy 92-98%
Prinsip Tata Laksana Trauma Vaskular
Arterial Pressure Index
Systolic pressure on the injured limb Systolic pressure on the uninjured arm
• API < 0.90
• Sensitivity 95%
• Specificity 97%
• Negative predictive value 99%
Trauma Vaskular
Konservatif
Endovaskular
Pembedahan
Damage Control Surgery and
Immediate Resuscitation
Rekontruksi vaskular
Fasciotomy
Terima kasih
