Popliteal scoring assessment for vascular extremity injuries in trauma study

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“…Rather than attempt to understand the "why" from retrospective data (a daunting task), obtaining granular information that can be easily obtained and reported to identify factors that portend a higher risk of amputation (systolic blood pressure on arrival, presence of orthopedic injury, presence or absence of Doppler signals), as well as identifying modifiable perioperative factors (antiplatelet therapy, ensuring Doppler signals upon leaving the OR when at all possible), will allow surgeons to improve communication and treatment algorithms for these high-risk patients. 1,6 Lastly, our data from the popliteal scoring assessment for vascular extremity injuries in trauma (POPSAVEIT) registry of nearly 500 popliteal arterial injuries have not found any increased risk of amputation with concomitant vein injury, or decision to treat said injury with ligation vs repair. There was also no difference in outcomes based on the decision to perform fasciotomies, and with nearly 85% limb salvage rates, this perhaps suggests adequate decision making with regard to compartment syndrome and ischemia time.…”

“…There was also no difference in outcomes based on the decision to perform fasciotomies, and with nearly 85% limb salvage rates, this perhaps suggests adequate decision making with regard to compartment syndrome and ischemia time. 1,6 Ultimately, no algorithm can adequately replace surgeon judgment. We appreciate Dr Ratnayake et al's continued efforts to improve outcomes in patients with lower extremity vascular injuries, we thank them for the thoughtful review of our papers, and we look forward to working together on how to determine and report a useful measure of ischemia grade.…”

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“…We appreciate the interest of, and letter to the editor by, Ratnayake et al regarding our report "Popliteal scoring assessment for vascular extremity injuries in trauma (POPSAVEIT) study." 1 They fear that POPSAVEIT "will join an array of prior tools which fail to reach the needed accuracy to support complex decision making in lower extremity vascular trauma." This concern presupposes that previous scoring systems are either impractical or insufficient in determining which limbs will be best served by undergoing primary amputation, which we completely agree with.…”

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter

“…Although the victims of traumatic vascular injuries are primarily young men, [1][2][3][4][5][6][7][8] patients may be of all ages and either sex. The frequency of these traumatisms has been growing and it is estimated that around 6% of civilian traumas involve vascular injury, 2 while they occur in up to 17.6% of military traumas.…”

“…[2][3][4][8][9][10][11][12] Involvement of limb vessels is common and is associated with risk of death and amputation. 4,5 Many different factors influence development of unfavorable clinical outcomes in cases of vascular traumatisms involving the limbs. One of the first factors to be established, more than 70 years ago, 13 was ischemia duration, which is directly correlated with the probability of limb amputation.…”