December 12, 2008

Popliteal Artery Injuries in an Urban Trauma Center with a Rural Catchment Area

Jon D. Simmons, MD, Joseph W. Gunter, MD, Fred W. Rushton, Jr., MD, Robert E. Schmieg, Jr., MD, Huey B. McDaniel, MD, Bilski R. Tracy, MD, John M. Porter, MD, Marc E. Mitchell, M.D..
University of Mississippi, Jackson, MS, USA.

OBJECTIVES:
The mechanism of injury, blunt or penetrating, and the length of time from injury to definitive surgical repair are potential predictors of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical delays are frequent. It is not uncommon for definitive operative repair to be delayed because of extended triage and transport times. This may affect limb salvage following vascular trauma.
METHODS:
All adult patients admitted to a University Level One Trauma Center with a popliteal artery injury between January 2000 and December of 2006 were identified. Demographic information, management, and outcome data were abstracted from the trauma registry and medical record. Body mass index (BMI), mangled extremity score (MESS), Gustilo open fracture score (GOFS), injury severity score (ISS), and time from injury to operative repair were determined.
RESULTS:
Forty-eight patients with popliteal artery injuries (50% blunt and 50% penetrating) were identified, all underwent operative repair. In 18 patients the time from injury to operative repair was equal to or greater than 6 hours. There were eight amputations (17%) and one death (2%). The amputation group had a higher MESS, 6.9 versus 4.8 (p=0.01), and longer length of stay, 46 versus 16 days (p=0.01), compared to the limb salvage group. BMI, ISS, GOFS, and time from injury to repair were not different between the amputation and limb salvage groups. The blunt injury group had a slightly higher amputation rate compared to the penetrating injury group, 25% versus 8.3% (p=NS).
CONCLUSIONS:
The length time from injury to operative repair is not a significant predictor of limb salvage or amputation in patients with popliteal artery injuries. Blunt injuries tend to result in amputation more frequently than penetrating injuries. MESS is the best predictor of amputation in patients with popliteal artery injuries.

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