Research Article
Volume 5 Issue 8 - 2021
Ischemic Time in Traumatic Vascular Injuries: Awareness, Practice, and Challenges in a Southern Nigerian State
Christian Emeka Amadi1 and Rex Friday Ogoronte A Ijah2*
1Consultant Cardiothoracic and Vascular Surgeon, Department of Surgery, University of Port Harcourt Teaching Hospital, and Lecturer, Cardiothoracic and Vascular Surgery Unit, Department of Surgery, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
2Consultant General Surgeon, Department of Surgery, Rivers State University Teaching Hospital and Lecturer, PAMO University of Medical Sciences, Port Harcourt, Rivers State, Nigeria
*Corresponding Author: Rex Friday Ogoronte A Ijah, Consultant General Surgeon, Department of Surgery, Rivers State University Teaching Hospital and Lecturer, PAMO University of Medical Sciences, Port Harcourt, Rivers State, Nigeria.
Received: July 05, 2021; Published: July 19, 2021


Aim: The aim of this study was to investigate the awareness, practice and challenges associated with the application of the knowledge of ischemic time in the care of surgical patients with traumatic vascular injuries among medical doctors in Port Harcourt.

Background: Traumatic vascular injuries can arise from military, civilian and even diagnostic and therapeutic procedures. The prevalence and significance of trauma as a public health concern has been severally reported. In the care of patients with traumatic vascular injuries involving the limb, there has been emphasis on ischemic time with a historical progression from limb amputations, through various forms of vascular repairs to microvascular repairs and replantation.

Materials and Methods: A questionnaire-based cross-sectional descriptive study was carried out among public tertiary and private medical doctors in Port Harcourt using the convenience sampling method, and analysed using SPSS version 20.0.

Results: A total of 460 respondents were recruited in this survey. One hundred and seventy-two respondents (37.4%) affirmed that ischaemic time in vascular injuries is interval between severance of vascular supply to a tissue and onset of tissue death. Opinion on success rate for the care of vascular injuries also varied among respondents, with 143 (31.1%) indicating 10% - 40% success rate, etc. Two hundred and sixty-nine (58.5%) respondents encountered challenges in the care of vascular injury patients including human, material, and environmental.

Conclusion: Knowledge of ischemic time was low. There is need for training and retraining of medical personnel to improve knowledge and care for patients with traumatic vascular injury.

Keywords: Traumatic Vascular Injuries; Ischemic Time; Awareness; Practice; Challenges; Port Harcourt; Nigeria


  1. Rich NM., et al. “Vascular trauma secondary to diagnostic and therapeutic procedures”. The American Journal of Surgery 6 (1974): 715-721.
  2. Klinkner DB., et al. “Pediatric vascular injuries: patterns of injury, morbidity, and mortality”. Journal of Pediatric Surgery 1 (2007): 178-183.
  3. Passos E., et al. “Tourniquet use for peripheral vascular injuries in the civilian setting”. Injury3 (2014): 573-577.
  4. Weaver FA., et al. “Difficult peripheral vascular injuries”. Surgical Clinics of North America 4 (1996): 843-859.
  5. Adegbehingbe O., et al. “Predictive factors for primary amputation in trauma patients in a Nigerian university teaching hospital”. East African Medical Journal 10 (2006): 539-544.
  6. Cornwell EE. “Current concepts of gunshot wound treatment: a trauma surgeon’s perspective”. Clinical Orthopaedics and Related Research® 408 (2003): 58-64.
  7. Sotero M. “A conceptual model of historical trauma: Implications for public health practice and research”. Journal of Health Disparities Research and Practice1 (2006): 93-108.
  8. Magruder KM., et al. “Trauma is a public health issue”. European Journal of Psychotraumatology1 (2017): 1375338.
  9. Shah DM., et al. “Advances in the management of acute popliteal vascular blunt injuries”. The Journal of Trauma8 (1985): 793-797.
  10. Field CK., et al. “Fasciotomy in vascular trauma: is it too much, too often?” The American Surgeon6 (1994): 409-411.
  11. Hancock H., et al. “History of temporary intravascular shunts in the management of vascular injury”. Journal of Vascular Surgery5 (2010): 1405-1409.
  12. Maleux G., et al. “Value of percutaneous embolotherapy for the management of traumatic vascular limb injury”. Acta Radiologica2 (2012): 147-152.
  13. Andreev A., et al. “Management of acute arterial trauma of the upper extremity”. European Journal of Vascular Surgery6 (1992): 593-598.
  14. Schlenker JD., et al. “Methods and results of replantation following traumatic amputation of the thumb in sixty-four patients”. The Journal of Hand Surgery1 (1980): 63-70.
  15. Wilgis ES. “Observations on the effects of tourniquet ischemia”. Journal of Bone and Joint Surgery 7 (1971): 1343-1346.
  16. Caldwell PC. “Intracellular pH”. International review of cytology. 5: Elsevier (1956): 229-277.
  17. Caldwell P. “Studies on the internal pH of large muscle and nerve fibres”. The Journal of Physiology1 (1958): 22-62.
  18. Bruner JM. “Saffty Factors In The Use Of The Pneumatic Tourniquet For Hemostasis In Surgery Of The Hand”. Journal of Bone and Joint Surgery1 (1951): 221-224.
  19. Paletta FX., et al. “Prolonged tourniquet ischemia of extremities: An experimental study on dogs”. Journal of Bone and Joint Surgery6 (1960): 945-950.
  20. Flatt AE. “Tourniquet time in hand surgery”. Archives of Surgery2 (1972): 190-192.
  21. Carden DL and Granger DN. “Pathophysiology of ischaemia–reperfusion injury”. The Journal of Pathology3 (2000): 255-266.
  22. Granger DN. “Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury”. American Journal of Physiology-Heart and Circulatory Physiology6 (1988): H1269-H75.
  23. Grisham MB., et al. “Modulation of leukocyte–endothelial interactions by reactive metabolites of oxygen and nitrogen: relevance to ischemic heart disease”. Free Radical Biology and Medicine4-5 (1998): 404-433.
  24. Granger DN. “Ischemia‐reperfusion: mechanisms of microvascular dysfunction and the influence of risk factors for cardiovascular disease”. Microcirculation3 (1999): 167-178.
  25. Lacerda L., et al. “Ischaemic postconditioning protects against reperfusion injury via the SAFE pathway”. Cardiovascular Research2 (2009): 201-208.
  26. Tobin SA., et al. “Vascular trauma at a university teaching hospital”. Australian and New Zealand Journal of Surgery11 (1988): 873-877.
  27. Meek A and Robbs J. “Vascular injury with associated bone and joint trauma”. British Journal of Surgery5 (1984): 341-344.
  28. Amaefula E., et al. “Risk Factors Associated with Limb Amputation in a Referral Hospital in Benue State Nigeria”. Journal of Advances in Medicine and Medical Research (2015): 1-7.
  29. Ubayawansa D., et al. “Major lower limb amputations: experience of a tertiary care hospital in Sri Lanka”. Journal of College of Physicians and Surgeons Pakistan 26 (216): 620-622.
  30. Chalya PL., et al. “Major limb amputations: A tertiary hospital experience in northwestern Tanzania”. Journal of Orthopaedic Surgery and Research1 (2012): 18.
  31. Ogundele O., et al. “Major limb amputations at a teaching hospital in the sub-Saharan Africa: Any change in trend?” East and Central African Journal of Surgery1 (2015): 140-145.
  32. Akiode O., et al. “Major limb amputations: an audit of indications in a suburban surgical practice”. Journal of the National Medical Association 1 (2005): 74.
  33. Nwafor I., et al. “The pattern and outcome of civilian vascular injury in a Teaching Hospital over a 7-year period”. World Journal of Cardiovascular Diseases 02 (2016): 44.
  34. Kidmas A., et al. “Lower limb amputation in Jos, Nigeria”. East African Medical Journal 8 (2004): 427-429.
  35. Chika AT and Onyekwelu J. “Traditional bone setters' gangrene: An avoidable catastrophe, 8 years retrospective review in a private orthopedic and trauma center in South-East Nigeria”. The Nigerian Journal of General Practice 1 (2016): 1.
  36. Yakubu A., et al. “Limb amputation in children in Zaria, Nigeria”. Annals of Tropical Paediatrics 2 (1995): 163-165.
  37. Ratnayake A., et al. “Outcomes of popliteal vascular injuries at Sri Lankan war-front military hospital: case series of 44 cases”. Injury 5 (2014): 879-884.
  38. Thomas MO., et al. “Arterial injuries in civilian practice in Lagos, Nigeria”. Nigerian Journal of Clinical Practice2 (2005): 65-68.
  39. Adeoye P., et al. “Civilian Vascular Injuries in an Urban African Referral Institution”. East African Medical Journal12 (2013): 404-408.
  40. Odatuwa-Omagbemi DO and Adiki TO. “Pattern at presentation of extremity gunshot injuries in Warri, Nigeria”. Nigerian Health Journal2 (2013): 85-90.
  41. Ezemba N., et al. “Traumatic common carotid—jugular fistula: report of 2 cases”. Texas Heart Institute Journal1 (2006): 81.
  42. Ekpe E., et al. “Cardiothoracic surgical emergencies in a Niger Delta Tertiary Health Institution: A 12 month appraisal”. Ibom Medical Journal1 (2008): 22-29.
  43. Okonta KE., et al. “Delayed brachial artery reconstruction after traumatic injury: a case for sustainment of surgical intervention”. The Pan African Medical Journal (2017): 27.
  44. Nwafor IA., et al. “The civilian vascular trauma in a low-income country: The determinant factors of morbidity and mortality”. Nigerian Journal of Medicine 2 (2020): 224.
  45. Onakpoya UU., et al. “Pattern of extremity arterial injury and outcome of repair in Southwest, Nigeria”. Nigerian Journal of Surgery: Official Publication of the Nigerian Surgical Research Society 1 (2019): 85.
  46. Onoh E., et al. “The Civilian Vascular Trauma in a Low‑Income Country: The Determinant Factors of Morbidity and Mortality”. Nigerian Journal of Medicine 2 (2020): 217-223.
  47. Sharma JP and Salhotra R. “Tourniquets in orthopedic surgery”. Indian Journal of Orthopaedics 4 (2012): 377-383.
  48. Alam HB and DiMusto PD. “Management of lower extremity vascular trauma”. Current Trauma Reports 1 (2015): 61-68.
  49. Bjerke HS and Stuhlmiller D. “Extremity vascular trauma”. Medical Journal1 (2002): 1-10.
Citation: Christian Emeka Amadi and Rex Friday Ogoronte A Ijah. “Ischemic Time in Traumatic Vascular Injuries: Awareness, Practice, and Challenges in a Southern Nigerian State”. EC Emergency Medicine and Critical Care 5.8 (2021): 02-11.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

October Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the October issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before November 04, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to