Traumatic Popliteal and Trifurcation Arterial Injuries: How Can We Predict the Ultimate Outcome?

During a sixteen-year period ending in March 1993, 63 patients with 88 popliteal or trifurcation arterial injuries underwent surgical management, and the ultimate outcome was recorded according to both mangled extremity severity score (MESS) and risk clas sification at Dicle University. There were 14 major (22.2%) and 3 minor (4.8%) ampu tations and 4 (6.3%) deaths. Of 40 patients with an ischemic period of more than eight hours, 13 required amputation. According to MESS, there were 28 patients with scores of 7 or more (44.4%). In this group 13 patients required amputation (46.4%), and 8 had a good outcome (28.6%). As regards patients' classification by risk factors of nerve injury, soft-tissue injury, and open fracture, 15 of 17 patients having one or less risk factor had a good outcome (88.2%), whereas 20 of 46 patients having two or more risk factors had good outcome (43.5%). A comparison of patients having one or less risk factor with those having three risk factors found statistical significance according to amputation rates (P < 0.05). The difference in amputation rates between 23 patients who were operated on within less than eight hours and 40 patients who were operated on within more than eight hours was statistically nonsignificant (P > 0.05).