Association Between Time to Revascularization and Amputation in Military Lower Extremity Vascular Injuries

Expeditious revascularization is key to limb salvage after arterial injuries, but the relationship between delay and amputation risk not well-defined in military trauma. We aimed explore based on time a cohort of injuries. A vascular injury database (2004-2012) was queried for femoropopliteal injuries that underwent revascularization. Time from initial (shunt or reconstruction) divided into groups <3, 3 6, 6 9, >9 hours injury, treatment, outcome characteristics compared across these groups. Times were available 120 cases. Shunting more common limbs revascularized earlier, while fasciotomy with later Amputation rates 10% <3 (n = 10), 21% 63), 24% 9 33), 50% 14; P .085) (Figure). The mean amputated 442 ± 348 minutes vs 347 183 salvaged (P .057). performed 19% <6 32% >6 .112). At hours, however, rate <9 .016). Fractures >9-hour than <9-hour (79% 44%; .016), severity otherwise similar. Among 91 limbs, neither nor other complications predicted by (Table). All seven had complication, most commonly infection (71%), three (42%) required skin graft close fasciotomies, which universally performed. Limb loss associated best results seen within hours. One-half amputation. Arterial shunting damage control earlier should be considered mainstay combat casualty care.TableInjury treatment revascularizationVariable<3 10)3-6 63)6-9 33)>9 14)P valueInjury Severity Score171615.517.5.388Blast mechanism6 (60)38 (60)23 (70)11 (79).03Mangled Extremity Score >72 (20)15 (24)4 (12)4 (29).499Tourniquet5 (50)43 (68)17 (51)9 (64).36Fracture3 (30)27 (43)17 (51)11 (79).061Concomitant vein injury9 (90)42 (67)14 (42)9 (64).026Fasciotomy7 (70)50 (79)29 (87)14 (100).152Arterial shunt8 (80)21 (33)1 (3.0)0 (0)<.001Vein reconstruction7 (70)46 (73)26 (79)10 (71).807Values are number (%). Open table new tab