Lower extremity arterial injury patterns and reconstructive outcomes in patients with severe lower extremity trauma: a 26-year review.
BACKGROUND
Management of severe traumatic lower extremity injuries remains a considerable challenge. Free tissue transfer is now a standard part of reconstruction for Gustilo IIIB and IIIC injuries. There is limited information on arterial injury patterns in this population. We undertook a review of our experience to gain insight on vascular injury patterns and surgical outcomes.


METHODS
A 26-year retrospective analysis was performed of all lower extremity Gustilo IIIB and IIIC injuries requiring microvascular reconstruction at New York University Medical Center. Patient demographics, Gustilo classification, angiographic findings (conventional/computed tomographic angiography/magnetic resonance angiography), recipient vessels, elapsed time from injury, flap choices, and outcomes were examined.


RESULTS
Two hundred twenty-two free flaps on 191 patients were performed from September 1982 until March 2008. There were 151 males and 40 females ranging in age from 4 to 83 years (median age 33 years). Patients sustained either Gustilo IIIB (170 patients) or IIIC (21 patients) open fractures. One hundred fifty-four patients had angiograms (78.2% IIIB, 100% IIIC). Sixty-six (42.9%) had normal 3-vessel runoff and 88 (57.1%) were abnormal. Sixty-one patients (31.9%) had anterior tibial injuries, 17 patients (8.9%) had posterior tibial injuries, and 30 (15.7%) had peroneal injuries. Sixty-three complications occurred (11 early thrombosis, 33 requiring secondary procedures, and 10 requiring amputation).


CONCLUSIONS
Angiography of severe lower extremity injuries requiring free flap reconstruction usually revealed arterial injury and is generally indicated. In our experience, the anterior tibial artery is most commonly injured and the posterior tibial artery is most likely to be spared and used as a recipient.
Haddock
Nicholas T
NT
Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
Weichman
Katie E
KE
Reformat
Derek D
DD
Kligman
Brad E
BE
Levine
Jamie P
JP
Saadeh
Pierre B
PB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000706:statistics & numerical data; D001158:Arteries / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000293:injuries / Q000601:surgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult