Successful management of trifurcation injuries.

Vascular injuries to the distal popliteal artery and its primary division(s) (trifurcation) combined with fracture(s) were analyzed for the years 1978 to 1983 at the Charity Hospital of Louisiana at New Orleans and Tulane Medical Center affiliates. This article does not include reports of isolated popliteal artery injuries. Thirty-six male patients with a mean age of 24 (16 to 47) years experienced 20 tibiofibular fractures and 16 tibial plateau fractures. Twenty-four injuries were secondary to penetrating trauma; the remaining 12 vascular injuries were the result of blunt trauma. All patients were angiographed preoperatively, resuscitated, treated with tetanus toxoid and antibiotics, and brought to the operating room in an average of 95 (30 to 244) minutes from entry to the emergency departments. Eight (22%) definitive below-knee amputations (BKA) (six [17%] with blunt trauma) and 28 (78%) reconstructive procedures were done initially. Twenty-four of the 28 (86%) patients had associated venous injury; 16 were repaired. Twenty of the 28 (71%) patients received fasciotomies There were eight late amputations in addition to the eight early definitive BKA; five secondary to related neurologic injury. Twenty of the 28 (71%) patients had successful repair of their arterial injury and total rehabilitation.