Comparison of military and civilian popliteal artery trauma outcomes.
OBJECTIVE
Popliteal artery injury has historically led to high amputation rates in both the military and civilian setting. Military and civilian popliteal injury patterns differ in mechanism and severity of injury, prompting us to compare modern management and report differences in outcomes between these two patient groups. We hypothesized that whereas amputation rates may be higher in the military, this would correlate with worse overall injury severity.


METHODS
Military casualties from 2003-2007 with a popliteal artery injury identified from the Joint Theater Trauma Registry were compared retrospectively with civilian patients presenting to a single level I institution from 2002-2009 with popliteal arterial injury. Demographics, mechanism of injury, coinjuries, Injury Severity Score (ISS), Mangled Extremity Severity Scores (MESS), interventions, and secondary amputation rates were reviewed. Descriptive statistics and unpaired t-tests were used to compare data. Statistical significance was P < .05.


RESULTS
The study group of 110 patients consisted of 46 (41.8%) military and 64 (58.2%) civilians with 48 and 64 popliteal artery injuries, respectively. The military population was younger (28 vs 35 years; P < .004), entirely male (46 [100%] vs 51 [80%]; P < .0001), and had more penetrating injuries (44 [96%] vs 19 [30%]; P < .0001). ISS (18.7 vs 13.9; P < .005) and MESS (7.3 vs 5.1; P < .0001) were higher in the military group. Limb revascularizations in both military and civilian populations were mostly by autogenous bypass (65% vs 77%) followed by primary repair (26% vs 16%), covered stent (0% vs 6%), or other procedure (ligation and/or thrombectomy) (9% vs 1%). Fasciotomy (20 [42%] vs 37 [58%]; P = .14), compartment syndrome (10 [21%] vs 15 [23%]; P = .84), and concomitant venous repair rates (14 [29%] vs 15 [23%]; P = .42) were not different between cohorts. There was no difference in the fracture rate (26 [54%] vs 41 [64%]; P = .43), but the civilian group had a higher rate of dislocation (1 [2%] vs 19 [30%]; P < .0001). Secondary amputation rates were significantly higher in the military (14 [29%] vs 8 [13%]; P < .03).


CONCLUSIONS
Although both civilian and military cohorts have high amputation rates for popliteal arterial injury, the rate of amputation appears to be higher in the military and is associated with a penetrating mechanism of injury primarily from improvised explosive devices resulting in a higher MESS and ISS.
Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, Houston, Tex. Electronic address: anahita.dua@uth.tmc.edu.
Anahita
A
Dua
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
Bhavin
B
Patel
Department of Cardiothoracic and Vascular Surgery, University of Texas Houston Medical School, Houston, Tex; Department of Surgery, Duke University, Durham, NC.
Sapan S
SS
Desai
Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, Houston, Tex.
John B
JB
Holcomb
Center for Translational Injury Research (CeTIR), Department of Surgery, UT Health, Houston, Tex.
Charles E
CE
Wade
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc.
Sheila
S
Coogan
Department of Surgery, Division of Vascular Surgery Walter Reed National Military Medical Center, Bethesda, Md.
Charles J
CJ
Fox
D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008889:Military Personnel; D011150:Popliteal Artery / Q000293:injuries* / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery