Sixty-nine limbs with infrapopliteal arterial
injuries were evaluated in 68 patients. Thirty-five (50%) cases were complicated by acute limb-threatening
ischemia. Management consisted of revascularization (26 limbs),
ligation (15 limbs),
fasciotomy only (2 limbs), observation (18 limbs), and primary
amputation (8 limbs). Penetrating
injuries (n = 35) had a 33% incidence of
ischemia and a reduced frequency of associated injury. One delayed
amputation (3%) was required. In contrast,
blunt injuries (n = 34) had a 68% incidence of
ischemia and a greater frequency of associated injury. There were 20
amputations in the blunt group, including eight primary
amputations performed in limbs with profound
ischemia, complex
open fractures, severe soft-tissue damage, and neural injury. Observation or
ligation of single arterial
injuries resulted in no early
amputations. Associated local
injuries in both groups included fracture or ligamentous disruption (64%), severe soft-tissue damage (32%), and nerve dysfunction (36%). In both groups, 15 of 35 ischemic limbs were salvaged by prompt revascularization (11 penetrating and four
blunt injuries). Aggressive revascularization with autogenous repair or bypass is recommended for management of penetrating
trauma. Though a good outcome will be achieved in some patients with combined blunt
trauma and infrapopliteal arterial injury, the probability of delayed
amputation and prolonged disability must be consciously integrated into the decision to pursue
limb salvage. The prognosis for
blunt injury complicated by arterial
ischemia is poor; thus the severity of associated local and remote
injuries will affect the results of revascularization program.