Predictors of amputation for popliteal artery injuries

Limb amputation among patients with surgically treated popliteal arterial injury: analysis of 15 years of experience in an urban trauma center in Cali, Colombia

“…The time to revascularization was not different among the categories age (p = 0.285), sex (p = 0.729), mechanisms of injury (p = 0.631), and fractures (p = 0.619). The median time to revascularization was 3.5 h [IQR, 2.5-7] when active bleeding was present and 10 h [IQR, 4-23] otherwise (p \ 0.001); 6 h [IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15] when distal pulse was absent and 10 h [IQR, otherwise (p = 0.020); and 7 h [IQR, [4][5][6][7][8][9][10][11][12][13][14] when initial ischemia was present and 10 h [IQR, otherwise (p = 0.097).…”

“…The time between the injury and surgery was 7 h [IQR, [4][5][6][7][8][9][10][11][12] in amputated patients and 8 h [IQR, 3.2-20] in patients without amputation. The odds of amputation among patients with less than 8 h between injury and surgery were 1.7 times the odds in patients with a time of more than 8 h; however, this association did not reach statistical significance (OR 1.70, 95% CI 0.75-3.83, p = 0.198).…”

“…However, previously published studies on predictive factors of leg amputation among patients with vascular injuries have had small numbers of patients, have not taken into account variables specifically related to surgical techniques, and have produced conflicting results. The current literature on this subject comes from both civilian and military experiences, with a wide variation in the management recommendations [5,[8][9][10][11][12][13][14][15]. A great deal of knowledge regarding outcome variables has been generated from the most recent military conflicts in Iraq and Afghanistan [11,16]; however, these results may not be necessarily applicable to civilian trauma centers in low-and middle-income countries.…”

A Critical Reappraisal of Indications for Fasciotomy After Extremity Vascular Trauma

“…In their review of 85 popliteal vascular injuries, Jaggers and colleagues 29 performed fasciotomies for 24 of 56 patients with popliteal artery injuries, an incidence similar to ours. In a recent review of 81 popliteal artery injuries (39 arterial and 42 combined), Fainzilber and associates 30 performed primary fasciotomy on 53% of their patients. Of the 35 patients who did not have a primary fasciotomy, 6 required an amputation.…”

“…Our overall amputation rate for popliteal injuries was 9%, an incidence similar to recent reports. [29][30][31] The incidence of neurologic damage after vascular injury to the extremity, whether due to a delayed fasciotomy or from the initial wounding agent, is often difficult to estimate. 15 It is, however, noteworthy that in the present series 4 of the 9 patients who had neurologic deficit in the extremity also had failure of the vascular repair and delayed fasciotomy.…”