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A Community Experience

James J. Peck, MD; A. Brent Eastman, MD; John J. Bergan, MD; Marc M. Sedwitz, MD; David B. Hoyt, MD; Donley G. McReynolds, MD

Arch Surg. 1990;125(10):1339-1344.

Abstract
• Preventing amputation continues to be a significant challenge when popliteal vascular injuries occur. A retrospective review of cases from the San Diego County (California) Trauma System identified 108 patients with 76 blunt and 32 penetrating arterial injuries. The limb preservation rate was 88%; there were 13 amputations. The fracture–dislocated knee injury and closerange shotgun blasts were particularly limb threatening. In general, the trauma system achieved rapid evaluation of injuries and early operative intervention. All 13 patients who underwent amputations presented with signs of severe ischemia. Concomitant injuries to the popliteal vein, tibial nerves, and soft tissue were significantly more frequent in patients who underwent amputations. The importance of complete fasciotomy for compartment hypertension, early reconstructive management of soft-tissue injuries, and expeditious arterial repair, frequently without preoperative roentgenographic suite arteriography, is emphasized. An aggressive, multidisciplinary approach is required to achieve a functional extremity when popliteal vascular trauma occurs.

(Arch Surg. 1990;125:1339-1344)

Author Affiliations
From the Trauma Research and Education Foundation, San Diego, Calif.

Footnotes
Accepted for publication June 9, 1990.

Read before the 61st Annual Meeting of the Pacific Coast Surgical Association, Laguna Niguel, Calif, February 20, 1990.

Reprints are not available.

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