A CLASSICAL VASCULAR DILEMMA: LIMB SALVAGE OR AMPUTATION ?

Popliteal artery injuries are the most challenging of all extremity vascular injuries. The popliteal vein, infrapopliteal arteries and the tibial nerve are the most commonly injured structures in penetrating popliteal trauma patients. Despite the experience obtained from the major wars in this century, ongoing advances in vascular surgery and near 100% limb salvage reports from current literature in popliteal artery penetrating trauma, there is still an ongoing debate about the management of such injuries. These injuries require a multidisciplinary approach for appropriate management. One of the major conflicts is the decision between amputation or salvaging the limb. According to the current data and our clinical experience, evaluation and decision making in this group of injuries is mostly patient dependent.In this case report, we present a young man with a left popliteal region gunshot injury. Immediately after the injury a limb salvage procedure was performed by our team. Now the patient has a conserved limb but functionally amputated extremity after 4 months of hospital stay.Key Words: Penetrating vascular injury,Gunshot wounds, Treatment.

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  • DeBakey NE, Simeone CF. Battle injuries of the arteries in World War II: an analysis of 2471 cases. Ann Surg 1946;123:534-537.
  • Wagner Wii, Yellin AE, Weaver FA, Stain SC Siegel AE. Acute treatment of penetrating popliteal artery trauma: the importance of soft tissue injury. Ann Vase Surg 1994;8:557-565.
  • Thomas DD, Wilson RF, Wiencek RG. Vascular injury about the knee. Improved outcome. Am Surg 1989;55:370-377.
  • Shah PM, Agarwal Pi, Babu SC, Stahl WM, Clauss Rti. Causes of limb loss in civilian arterial injuries. J Cardiovasc Surg 1986;27:278-281.
  • Weaver FA, Papanicolaou G, Yellin AE. Difficult peripheral vascular injuries. Surg Clin Morth Am 1996;76:843-859.
  • Fry WR, Smith RS, Sayers DV, et al. The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma. Arch Surg 1993; 128:1368-1372.
  • Whitman GR, Mc Croskey BL, Moore EE, Pearce Wfl, Moore FA. Traumatic popliteal and trifurcation vascular injuries: déterminais of functional limb salvage. Am J Surg 1987;154:681-684.
  • Russell WL, Sailors DM, Whittle TB, Fisher DF, Burns RP. Limb salvage versus traumatic amptutation. A desicion based on a seven part perdictive index. Ann Surg 1991;213:473-481.
  • Melton SM, Croce MA, Patten JM, et af Popliteal artery trauma. Systemic anticoagulation and intraoperative thrombolysis improves salvage. Ann Surg 1997;225:518-529.