[Treatment of delayed popliteal artery trauma of knees].
OBJECTIVE
To summarize the experience in treatment and diagnosis of popliteal artery trauma and to determine the factors for amputation.


METHODS
From February 1995 to January 2006, 28 patients with popliteal artery trauma were treated. The disease course was more than 8 hours. Of them, there were 25 males and 3 females, aging from 3 to 53 years. Trauma was caused by traffic accident in 12 cases, by falling from height in 3 cases, by firearm in 2 cases, by sharp instruments in 3 cases, by strangulation in 2 cases and by others in 6 cases. No arteriopalmus or weak arteriopalmus were observed in 18 cases and in 8 cases respectively. Popliteal artery exposure or active bleeding was seen in 2 cases; the popliteal arteries were examined by operation in 8 cases; color ultrasound Doppler flow imaging showed color flood flow signals were through popliteal artery and its branches in 20 cases. Defect size of popliteal artery was less than 5 cm in 7 cases and more than 5 cm in 9 cases. End to end anastomosis reconstruction by saphenous vein graft and direct suture was performed in 16 cases and ampulation in 12 cases. The time of the revascularization of the leg was 8-150 hours (mean 31. 8 hours).


RESULTS
All patients were followed up 6 months to 11 years with an average of 4.2 years. In 16 cases given end to end anastomosis reconstruction, 15 cases achieved revascularization and limb survival; lower limb function restored to normal within 1 year in 12 cases; foot drop and ankle joint contracture occurred in 3 cases and the survival rate of limbs was 94%. Amputation was given in 12 of 28 cases because of severe trauma. The rate of amputation was 43% and the rate of disability was 54%.


CONCLUSIONS
Popliteal artery trauma should be treated as soon as the diagnosis is made. If the revascularization is more than 8 hours or circulatory compensation is not complete, it will affect the leg survival. Delayed diagnosis and severe traumas are the cause of high rate of amputation in popliteal artery trauma.
Chen
Lianglong
L
Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, PR China. chenlianglong@vip.sina.com
Wang
Wanchun
W
Huang
Tianlong
T
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000293:injuries* / Q000601:surgery; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D055815:Young Adult