Management of traumatic popliteal vascular injuries in a level I trauma center: A 6-year experience.
BACKGROUND
Popliteal vascular trauma remains a challenging entity, and carries the greatest risk of limb loss among the lower extremity vascular injuries. Operative management of traumatic popliteal vascular injuries continues to evolve. We aim at describing our experience with such complex injuries, with associated patterns of injury, diagnostic and therapeutic challenges, and outcomes.


METHODS
From January 2006 to September 2011, 191 adult trauma patients presented to an urban level I trauma center in Miami, Florida with traumatic lower extremity vascular injuries. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications and outcomes.


RESULTS
Forty-seven (24.6%) patients were diagnosed with traumatic popliteal vascular injuries. Mean age was 38.1 ± 16.1 years, and the majority of patients were males (43 patients, 91.4%). There were 21 (44.7%) penetrating injuries, and 26 (55.3%) blunt injuries. Vascular repair with saphenous venous interposition graft and PTFE (polytetrafluoroethylene) grafting were performed in 36 (70.7%) and 2 (3.9%) patients, respectively. Blunt popliteal injuries were significantly more associated with major tissue loss, and length of hospital and intensive care unit (ICU) stays. The risk for amputation is increased with longer ICU stays and the use of PTFE grafting for vascular repair. The overall mortality rate in this series was 8.5%.


CONCLUSIONS
Blunt popliteal vascular injuries are associated with increased morbidity compared to penetrating trauma. Early restoration of blood perfusion, frequent use of interposition grafts with autogenous saphenous vein, and liberal use of fasciotomies play important role to achieve acceptable outcomes.
Ryder Trauma Center, Jackson Memorial Hospital, Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Jason D
JD
Sciarretta
Ryder Trauma Center, Jackson Memorial Hospital, Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA. Electronic address: igormacedo1@hotmail.com.
Francisco Igor B
FI
Macedo
Ryder Trauma Center, Jackson Memorial Hospital, Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Christian A
CA
Otero
Ryder Trauma Center, Jackson Memorial Hospital, Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Jose N
JN
Figueroa
Ryder Trauma Center, Jackson Memorial Hospital, Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Louis R
LR
Pizano
Ryder Trauma Center, Jackson Memorial Hospital, Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
Nicholas
N
Namias
D000328:Adult; D000671:Amputation, Surgical; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011150:Popliteal Artery / Q000293:injuries*; D011152:Popliteal Vein / Q000293:injuries*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery; D014193:Trauma Centers; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000601:surgery*
D011138:Polytetrafluoroethylene
Blunt; Penetrating; Saphenous venous graft; Traumatic popliteal vascular injuries