Factors Associated with Limb Salvage Following Complex Blunt Popliteal Injury

The purpose of this study is to report management techniques and factors associated with early limb salvage following high risk popliteal vascular injury. Additionally controversial aspects of popliteal vascular injury management unique to an Iranian trauma center are discussed. A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Patients were divided into two study groups: Group 1 Limb salvage and Group 2 Amputation. Subgroup analysis consisted of univariate analysis comparing the Group 1and Group 2 as well as multivariate analysis examining factors associated negatively and positively with the primary endpoint, limb salvage. Sixty of the patients (97%) were male, two female (3%); the mean age was 34.years (16-49 years).. The overall amputation rate in the present study was 23 amputations (37 %).On logistic regression analysis, significant (P<0.05) independent factors associated negatively with limb salvage were combined tibia and fibula fracture (OR 0.133; CI 0.017 -1.018), concomitant artery and vein injury (OR 0.039; CI 0.004- 0.407), ligation of venous injury (OR 0.326; CI 0.161- 0.660), lack of back flow after Fugarty catheter thrombectomy (OR 0.129; CI 0.023-0.729), while repair of popliteal artery and vein injury (OR 2.81; CI 2.22 -6.53) when present was associated with improved early limb salvage. Expeditious recognition of vascular injury, transport to repair and repair of associated venous injury when possible are necessary to optimize limb salvage. A low threshold for timely amputation when limb salvage is not possible is important to prevent life-threatening complications.