Popliteal artery injuries: the Kashmir experience

BACKGROUND: Popliteal artery injuries pose a serious threat to limb survival. Blunt trauma appears to be associated with a higher amputation rate than penetrating trauma, probably because of the more extensive nature of the injuries. METHODS: Two hundred seventy-two cases of popliteal artery injury were studied retrospectively from 1989 to 2001, a warlike period in Kashmir. Preoperative angiography was not performed. Thirty-two percent of patients had associated venous injury and 24.6% of patients had associated bone fracture. RESULTS: Overall morbidity was 55%, with the most common complication being infection (24%). Secondary amputation had to be performed in 16 patients (5.5%). The amputation rate was not influenced by cause of injury and type of repair or the presence of venous injury, but associated bone fracture significantly increased the risk of amputation (p < 0.05). The patients who underwent repair more than 12 hours after sustaining injury had a significantly greater amputation rate (p < 0.05). CONCLUSION: Prompt resuscitation, vascularization, and proper technique appear to be the only correctable factors that improve limb salvage.