title: Popliteal artery injuries in an urban trauma center with a rural catchment area: do delays in definitive treatment affect amputation?
abstract: Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect  limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment. All adult patients admitted to the Level I trauma center, the University  of Mississippi Medical Center, with a popliteal artery injury between January 2000 and December of 2007 were identified. Demographic information management and outcome data were collected. Body mass index, mangled extremity severity score (MESS), Guistilo open fracture score, injury severity  score, and time from injury to vascular repair were examined. Fifty-one patients with popliteal artery injuries (53% blunt and 47% penetrating) were identified, all undergoing operative repair. There were nine amputations (17.6%) and one death. Patients requiring amputation had a higher MESS,  7.8 versus 5.3 (P < 0.01), and length of stay, 43 versus 15 days (P < 0.01), compared with those with successful limb salvage. Body mass index, injury severity score, Guistilo open fracture score, or time from injury to repair were not different between the  two groups. Patients with a blunt mechanism of injury had a slightly higher amputation rate compared with those with penetrating trauma, 25.9 per cent versus 8.3 per cent (P = non significant). MESS, though not perfect, is the best predictor of amputation in patients with popliteal  artery injuries. Morbid obesity is not a significant predictor for amputation in patients with popliteal artery injuries. Time from injury to repair of greater than 6 hours was not predictive of amputation. This study further demonstrates that a single scoring system should be used with caution  when determining the need for lower extremity amputation.
authors.affiliation: Division of Trauma and Surgical Critical Care, The University of Mississippi Medical Center, Jackson, Mississippi, USA. jdsimmons@usouthal.edu
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Gunter
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmieg
authors.forename: Justin D
authors.initials: JD
authors.lastname: Manley
authors.forename: Fred W
authors.initials: FW
authors.lastname: Rushton
authors.forename: John M
authors.initials: JM
authors.lastname: Porter
authors.forename: Marc E
authors.initials: ME
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008922:Mississippi / Q000453:epidemiology; D011150:Popliteal Artery / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D012424:Rural Population; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014505:Urban Population; D014656:Vascular Surgical Procedures / Q000379:methods*