Civilian popliteal artery trauma: an eleven year experience with 83 injuries

Limb loss is the outcome in one third of previously reported popliteal artery injuries. This report summarizes 83 injuries with an amputation rate of 9.6%. Penetrating traumas accounted for 61 (73%) injuries and blunt traumas for 22 (27%). The incidence of amputation varied with injury type from none in seven stab wounds to three of 19 (15.8%) shotgun wounds. Distal ischemia or a pulse deficit highlights the presence of arterial trauma, and the external wound defines its site in most patients. Urgent operation is indicated by these findings. Equivocal findings suggest less compromised flow, and such patients are managed best by arteriographic confirmation before operation. Early systemic anticoagulation is indicated to decrease distal small-vessel thrombosis. The successful management of these injuries requires early and complete restoration of arterial and venous flow. This is accomplished most effectively by priority definitive reconstruction. Compulsive attention to complete restoration of arterial flow during the initial procedure is mandatory. Resection or bypass of all damaged arterial wall, liberal use of autogenous vein grafts, and repair of concomitant venous injuries enhance continued arterial patency. Routine distal catheter thrombectomy and frequent intraoperative arteriography promote and confirm complete reconstruction. Early performance of four quadrant fasciotomy is indicated if compartmental hypertension is suspected. Thorough debridement of injured and questionably viable soft tissue and adequate fracture stabilization are integral parts of successful revascularization.