Limb amputation among patients with surgically treated popliteal arterial injury: analysis of 15 years of experience in an urban trauma center in Cali, Colombia

García, Alberto; Sánchez, Á.; Millán, Mauricio; Carbonell, Juan Pablo Zebadúa; Ferrada, Ricardo; Gutiérrez, María; Peitzman, Andrew B.

doi:10.1007/s00068-011-0158-6

Cited by 8 publications

(8 citation statements)

References 37 publications

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“…4 Moreover, there was a certain degree of agreement with the insignificance of delay in revascularization af-fecting the amputation rate. 1,6,10 In this study, the interval shorter or longer than 8 hours did not make a significant difference ( P = 0.235) to a successful salvage. A delayed revascularization did not produce a significant difference ( P = 0.411) in the 39 cases having revascularization, neither.…”

Section: Discussionmentioning

confidence: 45%

“…1,16 Whether performing fasciotomy or not could alter the amputation rate was controversial. 4,6 Therefore, there has been no consensus with respect to a prophylactic fasciotomy after PAI. 12 In our institute, fasciotomy was performed when there was an observed or impending compartment syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…7 Since then, a cutoff of 6-hour ischemic time had been used for correlation studies regarding the outcomes after PAIs. 6,8 Nevertheless, patients who experienced PAIs but had collateral circulations could still obtain promising results after delayed revascularizations. An ischemic time less than 6 hours has been no longer a solid sole prognostic factor in PAIs.…”

mentioning

confidence: 99%

“…Among traumatic vascular injuries of lower limbs, the incidence of popliteal artery injuries (PAIs) had been noticed to be 20% to 70%, second to femoral artery injuries 1–3 . However, the amputation rate of lower limbs after PAIs was the highest (up to 71%) within the injuries of all extremity vessels 3–6 . Common concomitant injuries to the complex surrounding structures at the popliteal fossa, including the popliteal vessels, the knee joint, nerves, muscles, and bony structures, contribute to the high morbidity rate and difficulty in salvage of the lower limb in PAIs 2,4–6 .…”

mentioning

confidence: 99%

“…However, the amputation rate of lower limbs after PAIs was the highest (up to 71%) within the injuries of all extremity vessels 3–6 . Common concomitant injuries to the complex surrounding structures at the popliteal fossa, including the popliteal vessels, the knee joint, nerves, muscles, and bony structures, contribute to the high morbidity rate and difficulty in salvage of the lower limb in PAIs 2,4–6 . These had been usually resulted from blunt and high-energy impact injurie at this area, 2–4 within which a combined tibia-fibula fracture is the most common type of bony injury 3 …”

mentioning

confidence: 99%

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Revisiting Management Strategies for Popliteal Artery Injuries

Lin

Consuegra²,

Lin

2021

Ann Plast Surg

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Background: Popliteal artery injuries (PAIs) were reported to own the highest rates of limb loss in vascular injuries of extremities. The complex nature of PAIs makes the treatment more difficult. We aimed to present our cases using our proposed algorithm and revisit the strategies for management. Patients and Methods: A retrospective study of 45 cases with PAIs managed at the Kaohsiung Chang Gung Memorial Hospital over a 10-year period was conducted. The proposed algorithm for decision making was applied, which contains variables including the interval before surgery, the revascularization being delayed or not, the presence of fasciotomy, the acquisition of preoperative angiography, and the existence of collateral circulation. Whether the injured limbs were salvaged successfully avoiding amputation was recorded.Results: Of all the included 45 patients, the rate of a successful salvage of the injured limb from amputation was 71.1%. Six patients did not receive revascularization because of their poor conditions of the injured limbs. In terms of limb salvage in PAIs, the interval before surgery, the revascularization being delayed or not, the presence of fasciotomy, or the acquisition of preoperative angiography did not make a significant difference ( P > 0.05). Instead, an existence of collateral circulation at the distal injured limb was correlated to a significant higher rate of salvage, regardless of having revascularization or not ( P = 0.001 and < 0.001, respectively). Seven patients had the injured vessels repaired directly and all were prevented from amputation. In other patients who underwent vascular repair using a graft, vein graft (n = 20) showed a higher successful rate in salvage significantly than Gore-Tex graft (n = 9, P < 0.001). Conclusions: Collateral circulation determines much of the fate of limb salvage in PAIs. As a result, a delayed revascularization could be accepted as long as there is existence of collateral circulation at the distal injured limb. An autologous vein graft is favored when a direct repair is not able to be performed for revascularization. Although fasciotomy was not found to be associated with a successful salvage in this study, its importance could not be neglected and it should be performed when there is an observed or impending compartment syndrome.

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