Outcomes of popliteal vascular injuries at Sri Lankan war-front military hospital: case series of 44 cases.
OBJECTIVE
Traumatic injury to the popliteal vascular zone remains a challenging problem on the modern battlefield and is frequently associated with more complications than other vascular injuries. Limb salvage and morbidity (graft infection, thrombosis and delayed haemorrhage) were studied.


METHODS
All popliteal vascular injuries over an 8 month period admitted to the Military Base Hospital were analyzed. Local limb evaluation included confirmation of the presence of ischaemia, extent of soft tissue damage, muscle viability after calf fasciotomy, and neurological injury. Ischaemic time was recorded from the time of injury to definitive revascularization. If there was a prior attempt at reconstruction, the amputation was considered delayed.


RESULTS
For a series of 44 patients with popliteal vascular injury average time to presentation was 390min, 46% were completely ischaemic. Of those 39 (89%) had popliteal artery injuries. There were 24 (62%) complete popliteal artery transections and associated venous (69%) and osseous (46%) injuries. The preferred technique of repair was inter-position venous graft (IPVG) (54%). Eleven immediate amputations were performed (28%). There were 13 wound infections (33%), 5 early graft thromboses (5 of 21 IPVG, 238%), 2 anastomotic disruptions (2 of 21 IPVG, 9%), which resulted in 4 delayed amputations. Mortality was 5% (2 patients).


CONCLUSIONS
In this case series of popliteal artery injury early identification of limbs at risk, early four compartment fasciotomy, temporary intra-luminal shunting, definitive repair of concomitant venous injuries and aggressive treatment of haemodynamic instability were shown to be beneficial in achieving reasonable outcome in an austere environment with limited recourses.
Military Hospital, Colombo 5, Sri Lanka.
Amila
A
Ratnayake
Department of surgery, University of Peradeniya, Peradeniya, Sri Lanka.
Bandula
B
Samarasinghe
Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: rbalam@hadassah.org.il.
Miklosh
M
Bala
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D000071938:Fasciotomy; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D007869:Leg Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008889:Military Personnel; D011150:Popliteal Artery / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D013188:Sri Lanka; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013927:Thrombosis / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome; D014857:Warfare; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*
Fasciotomy; Popliteal artery injury; Primary and delayed amputation; War conflict