Popliteal artery injuries. Less ischemic time may lead to improved outcomes

Asensio, Juan A.; Dabestani, Parinaz J.; Miljkovic, Stephanie S.; Kotaru, Tharun R.; Kessler, John J.; Kalamchi, Louay D.; Wenzl, Florian A.; Sanford, Arthur P.; Rowe, Vincent L.

doi:10.1016/j.injury.2020.07.046

Cited by 21 publications

(22 citation statements)

References 56 publications

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“…5,[10][11][12][13] Numerous subsequent studies found that the diagnostic accuracy of MESS was insufficient and have called for the examination of additional predictors of amputation in this population. 7,8,11,[14][15][16] These scoring systems had a, perhaps overly ambitious, aim to determine a clear threshold for when limb salvage would be futile. To achieve this, the ideal score would have 100% specificity and high sensitivity because amputation is clearly irreversible.…”

Section: Discussionmentioning

confidence: 99%

Popliteal scoring assessment for vascular extremity injuries in trauma study

O’Banion

Dirks

Farooqui

et al. 2021

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Popliteal scoring assessment for vascular extremity injuries in trauma study

O’Banion

Dirks

Farooqui

et al. 2021

Journal of Vascular Surgery

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“…We have discussed and highlighted the lessons learned from this case. First, the most important factor in treating popliteal artery injury is achieving revascularization as soon as possible [3]. In our patient, an orthopedic surgeon performed external fixation first for the distal femoral fracture.…”

Section: A B C a Bmentioning

confidence: 96%

“…The most important prognostic factor is the revascularization time from the injury. Exceeding revascularization time by 6-8 hours can result in an unacceptably high amputation rate [1,3]. Early intervention can help achieve superior outcomes and improve the chances of successful limb salvage [5].…”

Section: A B C a Bmentioning

confidence: 99%

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Microsurgical Reconstruction of Lower Limb Using Thoracodorsal Artery Perforator Chimeric Free Flap after Popliteal Artery Revascularization: A Case Report

Choi

Chang

Park

et al. 2021

Arch Hand Microsurg

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Although traumatic popliteal artery injury is uncommon, it can significantly increase the risk of limb amputation because of the anatomical complexity and delayed diagnosis and treatment. Various tools are available for treatment. Recently, an endovascular approach has been attempted for such injuries; however, open surgical repair remains the standard treatment. An integrated and stepwise procedure involving multidisciplinary specialists, including emergency department personnel for initial evaluation, orthopedic surgeons for treating accompanying fractures or dislocations, vascular and plastic surgeons for vessel repair, and interventional radiologists for immediate diagnosis and implementation of the endovascular approach, is needed. Covering wound defects due to skin and soft tissue necrosis and irreversible ischemic damage remains difficult despite successfully revascularizing the injured vessels. Here, we describe a case of revascularization after popliteal artery injury along with successful reconstruction of a complex defect with a thoracodorsal artery perforator chimeric free flap when recipient vessel selection was limited.

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“…Previous studies have shown that age, high injury severity score, blunt trauma, injury location, duration of ischemia, and reperfusion injury are associated with replantation failure and delayed amputation [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

Risk and Prognostic Factors of Replantation Failure in Patients With Severe Traumatic Major Limb Mutilation: a Retrospective Cohort Study

Gao¹,

Yang

et al. 2021

Preprint

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Background: Traumatic mutilation of major limbs can result in limb loss, motor disability, or even death. Despite advancements in treatment, replantation failure could result in additional financial burden and severe psychosocial pressure on patients. Here, we determine the risk and prognostic factors of replantation failure in patients with traumatic major limb mutilation.Methods: In this retrospective cohort study, severed adult inpatients with traumatic major limb mutilation who underwent replantation from three hospitals in the Suzhou Ruixing Medical Group were included. Data obtained from electronic medical records were used to analyze predictors and risk factors for replantation failure.Results: From the 66 patients included, replantation failure occurred in 48 patients (72.7%). The area under the curve of the joint prediction of lactic acid on admission, 72 h cumulative fluid balance, and albumin level immediately postoperatively was 0.838 (95% CI, 0.722-0.954; P < 0.001) with a sensitivity of 89.7% and a specificity of 69.2%. Lower limb trauma (OR 8.65, 95%CI 1.64-45.56, P = 0.011), mangled extremity severity scores (OR 2.24, 95%CI 1.25-4.01, P = 0.007), and first 72 h cumulative fluid balance > 4885.6 ml (OR 10.25, 95%CI 1.37-76.93, P = 0.024) were independent risk factors for replantation failure.Conclusions: Lower limb trauma, mangled extremity severity scores, and cumulative water balance were associated with replantation failure. This implies that fluid management is necessary for major limb salvage. More studies are needed to explore the predictive power of indicators related to tissue oxygenation and wound healing for replantation failure.

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Popliteal artery injuries. Less ischemic time may lead to improved outcomes

Cited by 21 publications

References 56 publications

Popliteal scoring assessment for vascular extremity injuries in trauma study

Popliteal scoring assessment for vascular extremity injuries in trauma study

Microsurgical Reconstruction of Lower Limb Using Thoracodorsal Artery Perforator Chimeric Free Flap after Popliteal Artery Revascularization: A Case Report

Risk and Prognostic Factors of Replantation Failure in Patients With Severe Traumatic Major Limb Mutilation: a Retrospective Cohort Study

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