The increasing rate of secondary amputation in popliteal arterial injury associated with multi-organ injuries and hypotension.
OBJECTIVE
To study the role of hypotension and associated injuries in increasing the chances of secondary amputation in lower limb with vascular injuries.


METHODS
This study was conducted in the Department of cardiovascular and thoracic surgery( CVTS ), Sher-i- Kashmir Institute of Medical Sciences, ( SKIMS ) Srinagar Kashmir India and comprised all patients sustaining vascular injury due to different causes like road traffic accident, fire arm and blast injuries or falling from height during the last five years. Following admission to our Department, the patients were divided into two groups. The first group with associated injuries was hemodynamically unstable during vascular repair or in post-operative period and the second group had no associated injuries and was hemodynamically stable during vascular repair and in post-operative period.


RESULTS
During the past five years, 95 patients were operated for lower limb vascular injury in our department. Of these 25 patients had associated multi-organ injuries and were hemodynamically unstable and needed intensive care monitoring after surgical intervention. Additionally, 10 patients died due to associated multiple organ injuries, 10 needed amputation due to recurrent thrombosis of their anastomosis, and in five patients limb salvage was achieved. Seventy patients who had isolated limb vascular injuries with no associated injuries or hypotension were hemodynamically stable and were kept in low dependency unit after vascular repair. Only Four patients from this group needed amputation for thrombosis of the anastomosis.


CONCLUSIONS
[corrected] Patients with shock and related injuries face significant rate of amputation. These patients whether with multi-organ injuries or isolated vascular injuries need judicious treatment for hypovolumic shock during surgical intervention and in post-operative period.
Department of Cardiovascular and Thoracic Surgery1 SKIMS, Soura, Kashmir, India.
Farooq Ahmad
FA
Ganie
Department of Cardiovascular and Thoracic Surgery1 SKIMS, Soura, Kashmir, India.
Hafeezulla
H
Lone
Department of Cardiovascular and Thoracic Surgery1 SKIMS, Soura, Kashmir, India.
Mohd Lateef
ML
Wani
Department of Cardiovascular and Thoracic Surgery1 SKIMS, Soura, Kashmir, India.
Nasir-U-Din
NU
Wani
Department of Cardiovascular and Thoracic Surgery1 SKIMS, Soura, Kashmir, India.
Abdual Ganie
AG
Ahangar
Department of General Surgery, Soura, Kashmir, India.
Shabir Ahmad
SA
Ganie
Amputation; Hypovolumic Shock; Thrombosis; Vascular Injuries