Publications
http://repository.rjt.ac.lk/handle/123456789/936
2024-03-29T14:39:08ZA Rare Case of Life-Threatening Bleeding Caused by a Jejunal GIST
http://repository.rjt.ac.lk/handle/123456789/5529
A Rare Case of Life-Threatening Bleeding Caused by a Jejunal GIST
Liyanage, A.S.D.; Thalgaspitiya, S.P.B.; Kalaiselvan, R.; Rajaganeshan, R.
2019-01-01T00:00:00ZSri Lankan perspective of combat extremity vascular trauma: lessons learned and implications for future directives
http://repository.rjt.ac.lk/handle/123456789/5528
Sri Lankan perspective of combat extremity vascular trauma: lessons learned and implications for future directives
Rathnayake, Amila; Worlton, Tamara J.; Thalgaspitiya, S.P.B.
2019-01-01T00:00:00ZA new ischemic grading system to aid combat extremity vascular injury decision making
http://repository.rjt.ac.lk/handle/123456789/5401
A new ischemic grading system to aid combat extremity vascular injury decision making
Ratnayake, Amila; Reva, Viktor.A.; Bala, Miklosh.; Jayatilleke, Achala.U.; Thalgaspitiya, Sujeewa.P.B.; Kauvar, David.S.; Worlton, Tamara.J.
Abstract
Introduction
In resource limited combat settings with frequent encounters of mass casualty incidents, the
decision to attempt limb salvage versus primary amputation is refined over time based on
experience. This experience can be augmented by grading systems and algorithms to assist in
clinical decisions. Few investigators have attempted to explicitly grade limb ischemia according
to clinical criteria and study the impact of limb ischemia on clinical outcome. We suggest a new
ischemia grading system based on the Rutherford ischemic classification and the V.A. Kornilov
classification which we adapted to apply to the combat setting. This new tool was then
retrospectively applied to combat trauma patients from the Sri Lankan Civil War.
Method
We retrospectively queried a prospectively maintained, single surgeon registry containing 129
extremity vascular injuries managed at a Role 3 military base hospital (MBH) from 2008
December to June 2009 during the last phase of Sri Lankan Civil war. 89 patients were analyzed
for early limb salvage according to the modified Kornilov extremity ischemia index (MKEII).
2020-08-07T00:00:00ZA critical appraisal of impact of compounding factors in limb salvage decision making in combat extremity vascular trauma
http://repository.rjt.ac.lk/handle/123456789/5400
A critical appraisal of impact of compounding factors in limb salvage decision making in combat extremity vascular trauma
Ratnayake, Amila.S,; Bala, M.; Fox, C.J.; Jayatilleke, A.U.; Thalgaspitiya, S.P.B.; Worlton, T.J.
ABSTRACT
Objective For more than half a century, surgeons who
managed vascular injuries were guided by a 6-hour
maximum ischaemic time dogma in their decision to
proceed with vascular reconstruction or not. Contemporary
large animal survival model experiments aimed at
redefining the critical ischaemic time threshold concluded
this to be less than 5 hours. Our clinical experience from
recent combat vascular trauma contradicts this dogma
with limb salvage following vascular reconstruction with
an average ischaemic time of 6 hours.
Methods During an 8-month
period of the Sri Lankan
Civil War, all patients with penetrating extremity vascular
injuries were prospectively recorded by a single surgeon
and retrospectively analysed. A total of 76 arterial injuries
was analysed for demography, injury anatomy and physiology,
treatment and outcomes. Subsequent statistical
analysis was performed to evaluate the impact of independent
variables to include; injury anatomy, concomitant
venous, skeletal trauma, shock at presentation and time
delay from injury to reconstruction.
Results In this study, the 76 extremity arterial injuries
had a median ischaemic time of 290 (IQR 225–375) min.
Segmental arterial injury (p=0.02), skeletal trauma
(p=0.05) and fasciotomy (p=0.03) were found to have
a stronger correlation to subsequent amputation than
ischaemic time.
Conclusions Multiple factors affect limb viability
following compromised distal circulation and our data
show a trend towards various subsets of limbs that are
more vulnerable due to inherent or acquired paucity
of collateral circulation. Early identification and prioritisation
of these limbs could achieve functional limb
salvage if recognised. Further prospective research should
look into the clinical, biochemical and morphological
markers to facilitate selection and prioritisation of limb
revascularisation.
2020-04-28T00:00:00Z