Vascular Reconstruction Is Not Warranted in Most Civilian Traumatic Shank Vascular Injuries.
BACKGROUND
Operative management of traumatic shank vascular injuries (SVI) evolved significantly in the past few decades, thereby leading to a dramatic decrease in amputation rates. However, there is still controversy regarding the minimum number of patent shank arteries sufficient for limb salvage.


METHODS
Between January 2006 and 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
A total of 48 (25.1%) patients were identified comprising 66 traumatic shank arterial injuries. Mean age was 38.2 ± 13.4 years, and the majority of patients were men (40 patients, 83.3%) presenting with blunt injuries (35 patients, 72.9%). Ligation was performed in 38 injured arteries (57.6%) and no vascular intervention was required in 20% of the patients. Vascular reconstruction was performed in only 6 patients (9.1%): 4 (6.1%) with concurrent popliteal trauma, 1 (1.5%) isolated anterior tibial, and 1 (1.5%) 3-vessel injury. Autogenous venous interposition conduit and polytetrafluoroethylene grafting were performed in 5 (7.6%) and 1 (1.5%) patient, respectively. All amputations (8 patients, 16.7%) occurred in blunt trauma patients presenting with unsalvageable limbs. The overall mortality rate in this series was 2.1%.


CONCLUSIONS
Civilian shank arterial injuries are associated with acceptable rates of limb loss. Patients with a single-vessel patent inflow did not require vascular reconstruction in this series. Arterial reconstruction may no longer be determinant for successful management of isolated and double arterial SVI, whereas it is yet essential in the presence of 3-vessel or concurrent above-the-knee vascular injuries. Further investigation including larger number of patients is still warranted to define the role of conservative management in these complex injuries.
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL. Electronic address: igormacedo1@hotmail.com.
Francisco Igor B
FI
Macedo
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Jason D
JD
Sciarretta
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Steve
S
Chausse
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Danny
D
Sleeman
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Louis R
LR
Pizano
Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Nicholas
N
Namias
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D001158:Arteries / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005431:Florida; D006801:Humans; D008026:Ligation; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014680:Veins / Q000637:transplantation; D055815:Young Adult