LOWER-LIMB TRAUMA WITH INJURY TO THE POPLITEAL VESSELS

A retrospective analysis of blunt trauma to the lower extremity with i njury to the popliteal vessels was undertaken in an attempt to determi ne the major predictors of outcome and to expose the shortcomings of o ur management. Thirty-one patients with lower extremity trauma includi ng a popliteal artery injury were admitted to our clinic between 1979 and 1993. Two patients died of hemorrhagic shack or from associated le sions. Amputation of the leg was performed primarily in one patient be cause of massive tissue damage and secondarily in five patients becaus e of uncontrolled local infection (two patients), excessive tissue dam age (two patients), and persistent ischemia (one patient who later die d). A peripheral neurologic deficit resulted in 12 of 24 non-amputated extremities. Three additional patients suffered sequelae from bone an d joint damage. In all, nine patients recovered completely from their limb injury. Severe ischemia of the leg was found to be an indicator o f major limb damage and was a strong determinant of poor outcome. Of 1 8 patients with severe ischemia, two died (one after amputation), five were amputated, and eight were left with a peripheral neuropathy. Onl y two patients recovered completely. Of 13 patients with relative isch emia, five recovered completely and four sustained a peripheral neurop athy. The deleterious effects of delayed revascularization were eviden t in four patients who developed a peripheral neuropathy secondarily. Morbidity from the ischemic insult could have been reduced in seven pa tients: the diagnosis was missed in two, its seriousness not realized in one, and a non-optimal management led to an excessive ischemic time in four, The magnitude of skeletal and soft tissue injury, alone or i n combination, was also strongly associated with an increased morbidit y. Most patients with blunt lower limb trauma and popliteal vascular i njury are left with serious sequelae from associated neuro-musculo-ske letal damage and from ischemia. Although the magnitude of the first va riable is determined by initial trauma and cannot be altered, a consta nt awareness of possible arterial injury in Lower limb trauma, and adh erence to a plan of management according to the ischemic state of the leg, should help avoid the additional deleterious effects of prolonged ischemia.