Controversial case: Revascularization of a popliteal vascular injury of poor prognosis

Popliteal injuries are significant health risk that could induce permanent functional impairment, limb loss, and in some cases death. Currently, there is a controversy about the required treatment between amputation and a limb salvage surgery, which in some cases could cause more prominent functional impairment than the amputation. Different indicators help to predict, in some extent, the risk of amputation, however most of them were described two decades ago.

A patient with a prolonged hot ischemia and in critical conditions, which had no favorable clinical indicators for revascularization is shown and discussed. By means of intraoperative analysis, it was decided to perform a revascularization for limb salvage, progressing with a positive outcome.

Advancements in medical and vascular surgery, such as osteovascularized grafts, the use of flaps to cover large defects, the Ilizarov method for bone elongation and stabilization, the use of growth factors, negative pressure therapy, and the use of extracellular matrix, the improvements of intensive care units (ICU), among others, make necessary to revisit and reevaluate these indicators. The accuracy of these indicators has dropped significantly, and currently the medical evaluation cannot longer only depend on them.

Our results suggest the need to revisit and improve the predicting indicators scores for amputation prognosis that should include a preoperative and transoperative analysis.