Related Experiment Video
Updated: May 31, 2025
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Outcomes of popliteal artery injuries in a level 1 trauma centre: a 6-year review
Kewen van Rensburg1,2, Wilme Steyn3,4, Ismail Cassimjee3
1Department of Surgery, Division of Vascular Surgery, Charlotte-Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa. kewen191@gmail.com.
Insights
Delayed surgery significantly increases limb loss in patients with penetrating or blunt limb trauma in South Africa. Revascularization is recommended even with prolonged ischemia, but scoring systems are unreliable for delayed cases.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- Limb loss due to trauma is a significant concern globally.
- Understanding factors influencing limb loss is crucial for improving patient outcomes.
- Published scoring systems aim to predict limb salvage but may not be accurate in all settings.
Purpose of the Study:
- To identify modifiable and non-modifiable factors contributing to limb loss in patients with penetrating and blunt limb trauma (PAI).
- To evaluate the relevance and accuracy of existing scoring systems (MESS, POPSAVEIT) for PAI in a South African state hospital context.
Main Methods:
- A retrospective review of patients over 18 years old with PAI was conducted.
- Data were collected from the CMJAH trauma unit between January 1, 2017, and December 31, 2022.
- Patient records were analyzed for demographics, injury type, time to surgery, and outcomes (amputation vs. limb salvage).
Main Results:
- Sixty-four patients were analyzed; 53.1% had penetrating trauma and 46.9% had blunt trauma.
- Gunshot wounds were the most common mechanism of injury.
- The primary amputation rate was 28.6%, with a 40% amputation rate for blunt trauma and 33.3% for penetrating trauma.
- A significant delay to surgery (>6 hours) was observed in 73.4% of patients, with a mean total delay of 838 minutes.
- Successful limb salvage was achieved in 63.5% of cases, and the secondary amputation rate was 7.8%.
Conclusions:
- The primary amputation rate in this South African cohort is higher than international benchmarks, likely due to prolonged ischemia.
- Revascularization should be considered even with prolonged ischemia, especially if at least two viable compartments are present upon fasciotomy.
- MESS and POPSAVEIT scoring systems demonstrated unreliability in patients with delayed presentations.
- Strengthening referral triage to Level 1 Trauma centers is recommended to reduce delays and improve outcomes for PAI.
Purpose:
To determine modifiable and non-modifiable factors contributing to limb loss in PAI the relevance and accuracy of published scoring systems for PAI within a South African State hospital.
Methodology:
Retrospective review of patients (> 18 years) with PAI, presenting to CMJAH trauma unit from 1 January 2017 to 31 December 2022.
Results:
Sixty-four patient records were analysed. Thirty (46.9%) had blunt trauma and thirty-four (53.1%) had penetrating trauma. Gunshot wounds (GSW) were the most common mechanism of injury (MOI). Blunt PAI had a 40% amputation rate and penetrating trauma, 33.3%. Forty-seven (73.4%) had a delay to surgery of > 6 h. The mean time to arrival at our emergency department was 478 min, and the mean time from arrival to surgery was 368 min (total delay of 838 min). The primary amputation rate was 28.6%, and 63.5% had successful limb salvage surgeries. The secondary amputation rate was 7.8%.
Conclusion:
Compared to international literature, our rate of primary amputation is high (10% vs. 28.8%) and prolonged ischaemia is the likely cause. Only 17 (26.6%) patients presented before 6 h. Of the 45 patients that had an attempt at revascularisation, 7.8% had a secondary amputation. Thus, despite prolonged ischaemia, revascularisation should be attempted in patients with at least two viable compartments on fasciotomy. The MESS and POPSAVEIT scoring systems should not be relied on in patients with delayed presentations. Strengthening referral triage for suspected PAI to Level 1 Trauma centres directly will decrease the delays and likely improve the outcomes.
More Related Videos
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
08:05Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
Related Concept Videos
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:15Veins of Lower Limbs
Formed by the union of the medial and lateral plantar veins, the posterior tibial vein, rising through the calf muscle, assimilates the fibular vein. The anterior tibial vein, a superior extension of the foot's dorsalis pedis vein, merges with the posterior tibial vein at the...