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Trauma to the popliteal vessels is potentially dangerous, and limb loss may result,
especially with delayed diagnosis. Three anatomic factors contribute to the seriousness of the
outcome: proximity of the artery to bone, superficial position of the artery and consequent lack
of protection, and frequent associated injury to associated collateral blood vessels. Serious
surgical managements should be done immediately.
The goal of surgical management is limb salvage. Patients with life-threatening injuries
should undergo a damage control approach, and a small number of patients with devastating
injuries will require amputation.
Priorities include definitive control of bleeding sites with vascular ligation or placement
of a vascular shunt, debridement of devitalized or grossly contaminated tissue, and quick
stabilization of any fractures, if possible.
2. Vascular ligation — In general, ligation (arterial or venous) is best tolerated with distal
or minor vascular injury. There is some degree of redundancy of circulation in the
forearm and leg. Ligation of any one of the three vessels of the leg (anterior tibial,
peroneal, posterior tibial) is a damage control option provided that either the anterior or
posterior tibial vessel is patent to provide in-line flow to the foot.
3. Vascular shunting — A less morbid damage control approach (compared with ligation)
for patients with extremity vascular injury is vascular shunting, a technique that has been
available for over 50 years. A vascular shunt is a synthetic tube that is inserted into the
vessel and secured proximally and distally. Vascular shunts are typically used for larger,
more proximal arteries and veins such as the femoral, popliteal, and brachial vessels.
6. What are the possible complications of this type of penetrating popliteal injury and possible
post-operative complication?
Patients with severe lower extremity injuries have a high incidence of complications, including;
References
Miles, J. T., De la Rocha, A. G., & Baird, R. J. (1977, March 19). 3. Current approaches to popliteal artery
repair. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1879205/