LATE ARTERIAL REPAIR FOR LOWER LIMB OR KNEE SALVAGE

The objective of this report is to prove that even after development of ischemic necrosis of the muscles and nerves, we can still save the extremity or the knee and even several days after arterial injury, perform arterial repair and other mentioned procedures. Thus we can retain a functionally satisfactory leg or knee joint, which is far better than classic above-knee amputation and utilization of an artificial leg. 28 cases have been chosen in this series, and arterial repair was performed 24 to 72 hours after arterial injury. The arterial injuries were at or above knee level, all the muscles of the leg were found to be necrotic at the time of arrival, and the leg was senseless below the knee or mid-shin. 23 cases underwent leg salvage, and in five who had fractured tibia or necrosis of the skin of the sole or around the ankle, mid-shaft amputation with knee salvage was performed, rather than above-knee amputation. Only three unsuccessful results were encountered, which the authors feel were due to improper case selection, and one mortality was reported, due to pulmonary embolism. The comparative results were far better than above-knee amputation, both in below-knee amputation and leg salvage, and the patients did not consider themelves disabled either physically or mentally. With proper care, the patients were able to lead completely normal lives with no job opportunity limitations. The authors conclude that even several days after arterial injury and despite ischemic necrosis of muscles and nerves, lower limb or knee salvage is still possible, and classic "a-k"amputation is not the only alternative.