Progress in the management of complex
vascular injuries of the extremities has not eliminated the necessity for
amputation. An analysis of 100 consecutive patients treated at the Lincoln Medical and Mental Health Center during 1974-1980 disclosed that five
amputations followed 24 instances of blunt
trauma, but only one minor
amputation of toes was required in 76 patients after repair of arterial
injuries associated with
penetrating wounds. Extensive skeletal, muscular and skin loss at the sites of blunt
trauma precluded salvage of two limbs. Physicians' failure to suspect arterial injury on admission in three patients with blunt
trauma caused delay in the diagnosis and management of occlusive arterial injury that ultimately led to three
amputations. In contrast, limited soft tissue damage accompanying
penetrating wounds and high index of suspicion resulted in expeditious repair, accounting for the minimal risk of limb loss.
Amputation may be obligatory in the presence of extensive skeletal and soft tissue destruction. However, limb loss due to delay in diagnosis is preventable. In every instance of blunt
trauma to extremities, we advocate the same suspicion of
vascular injuries as in penetrating
trauma, with early liberal use of angiography whenever pulses are not absolutely normal, and prompt revascularization of ischemic limbs.