Lower extremity traumatic vascular injury at a level II trauma center: an analysis of limb loss risk factors and outcomes

Aim. The objectives were to review in our series the risk factors, management and outcomes of patients who sustained vascular injuries in the lower limbs and to determine the effect of risk factors and treatment on the outcome of the injured extremity. Methods. Fifty-six patients submitted to surgical treatment were retrospectively reviewed. Results were analysed in terms of type of operation and reconstruction, intraoperative and 30 day complications, reconstruction occlusion, major amputation and mortality. Results. The mechanism of trauma was blunt in 30.4% and penetrating in 69.6%. The overall primary amputation rate was 5.4%, the overall secondary amputation rate was 1.8%. The overall intraoperative and postoperative mortality were 1.8% and 5.4% respectively. At univariate analys is, the presence of compartment syndrome and ischemia time >6 hours were associated with a significantly higher risk of early reconstruction thrombosis (both P=0.03). It showed also that the number of patent vessels (P=0.0000) and the presence of a MESS score >7 (P=0.0000) significantly affected primary amputation, and that the occurrence of postoperative deep wound infection or sepsis (P=0.0000), of tibio-peroneal trunk injury (P=0.003) and of a MESS score >7 (P=0.004) significantly affected secondary amputation. Conclusion. The number of patent arteries (0-1), the presence of a MESS score >7, the incidence of tibio-peroneal trunk injury and the occurrence of postoperative deep wound infection are significant independent factors for limb loss. The presence of compartment syndrome and of ischemia time >6 hours are associated with a significantly higher risk of early reconstruction thrombosis.