Arterial injuries below the knee: fifty-one patients with 82 injuries

Clinical features of tibial and peroneal artery injuries are characterized in a review of 51 patients with 82 injured arteries. Injuries were penetrating in 34 (67%) patients and blunt in 17 (33%). Physical findings suggested arterial injuries in 42 (82%) patients, but nine had no signs of vascular trauma. Nineteen patients with no palpable distal pulses had average preoperative delays of nearly 5 hours, suggesting a lack of appreciation for the morbid potential of these injuries. Operations included ligations of single-vessel injuries and arterial reconstructions in the 21 (41%) patients with two or more injured vessels. Amputations were necessary in eight (16%) patients. Limb loss was more frequent with blunt trauma (23%), shotgun wounds (33%), initial absent pulses (32%), and three injured vessels (60%). The frequency of limb loss with these injuries emphasizes the importance of early diagnosis, expedient operation, and thorough revascularization.