Penetrating injuries of the popliteal artery

Military experience has consistently emphasized the unacceptably high amputation rate associated with popliteal arterial trauma. In this group of patients there were 23 arterial injuries and 26 injuries involving both an artery and a vein. The loss of only 5 limbs in this series was directly related to the policy of repair of the artery by both single segment vein grafts and by 'panel' grafts. Panel grafts are prepared by removing the long saphenous vein at ankle level, splitting it longitudinally and then dividing it transversely at the midpoint. The two segments of vein are placed side by side and sutured along each side, a no. 14 or 16 Ch. Foley catheter being used as a stent. Fasciotomy, carried out at an early stage in the postoperative course, and prompt re-exploration of repair sites when suspicion arose as to the effectiveness of limb circulation, were also major factors in establishing a successful outcome in so many patients.