Tourniquet use for civilian extremity trauma.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] 12. Injury. 2020 Nov;51(11):2524-2531. doi: 10.1016/j.injury.2020.07.046. Epub 2020 Jul 23. Popliteal artery injuries. Less ischemic time may lead to improved outcomes. Asensio JA(1), Dabestani PJ(2), Miljkovic SS(3), Kotaru TR(4), Kessler JJ(5), Kalamchi LD(6), Wenzl FA(7), Sanford AP(8), Rowe VL(9). Author information: (1)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: juanasensio@creighton.edu. (2)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: parinazdabestani@creighton.edu. (3)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: stephaniemiljkovic@creighton.edu. (4)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: tharunkotaru@creighton.edu. (5)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: johnkessler@creighton.edu. (6)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: louaykalamchi@creighton.edu. (7)Department of Surgery, Creighton University School of Medicine, Omaha, United States. Electronic address: flo.wenzl@hotmail.com. (8)Department of Surgery, Loyola University Stritch School of Medicine, IL, United States. Electronic address: asanford@lumc.edu. (9)Department of Surgery, University of Southern California Keck School of Medicine, CA, United States. Electronic address: vincent.rowe@med.usc.edu. Comment in Injury. 2020 Dec;51(12):2990-2991. doi: 10.1016/j.injury.2020.10.011. BACKGROUND: Popliteal artery injuries are rare. They have high amputation rates. OBJECTIVES: To report our experience, identify predictors of outcome; mechanism of injury (MOI), Mangled Extremity Severity Score (MESS) score and length of ischemic time. We hypothesized that ischemic time as close to six hours results in improved outcomes. METHODS: Retrospective 132-month study. All popliteal artery injuries. Urban Level I Trauma Center. OUTCOME MEASURES: MOI, ISS, MESS, ischemic time, risk factors for amputation, role of popliteal venous injuries, and limb salvage. STATISTICAL ANALYSIS: univariate and multivariate. RESULTS: 76 patients - 59 (76.1%) males and 17 (22.4%) females. MOI: penetrating - 54 (71%). MESS for penetrating injuries - 5.8 ± 1.5, blunt injuries - 5.6 ± 1.8. Admission-perfusion restoration (n = 76) - 5.97 hours (358 minutes). Ischemic time was not predictive of outcome (p = 0.79). Ischemic time penetrating (n = 58) 5.9 hours (354 ± 209 minutes), blunt 6.1 hours (371 ± 201 minutes). Popliteal arterial repairs: RSVG 44 (58%), primary repair 21 (26%), PTFE 3 (4%), vein patch 2 (2%), ligation 2 (3%), exsanguinated 4 (6%). No patients underwent stenting. Popliteal Vein: Repair 19 (65%), ligation 10 (35%). Fasciotomies 45 patients (59%). OUTCOMES: Limb salvage - 90% (68/76). Adjusted limb salvage excluding intraoperative deaths - 94% (68/72). Selected patient characteristics; MOI: penetrating vs. blunt - age (p