Salvage of Lower Limb in Delay-Diagnosed Popliteal Artery Transection Caused by Blunt Trauma

Special Article – Surgery Case Reports

Austin J Surg. 2020; 7(1): 1240.

Salvage of Lower Limb in Delay-Diagnosed Popliteal Artery Transection Caused by Blunt Trauma

Chin-Choon Yeh*

Division of Plastic Surgery, Department of Surgery, Chi- Mei Medical Center, Taiwan

*Corresponding author: Chin-Choon Yeh, Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, No.901, Jhonghua Rd., Yongkang Distinct, Tainan County 71004, Taiwan

Received: January 01, 2020; Accepted: January 22, 2020; Published: January 29, 2020


Background: Transection of poplieal artery could block majority of lower limb perfusion, results in ganrene and amputation finally.

Aim and Objectives: This article presents a case of successful salvage of lower limb in delay-diagnosed popliteal artery transection and review of the literature. Total transection of popliteal artery could block nearly all perfusion to the lower limb and subsequently causes gangrene that need to be amputated.

Materials and Methods: The patient was a 31-year-old male suffered from left lower limb blunt trauma in a traffic accident. The mechanism is falling down from ridding motorcycle and hitting a telephone pole. Initially vessel injury was not identified and he was discharged from ER after 7-hour observation. However, he felt severe pain and swelling with large area ecchymosis of his left leg after working. So he came back to our ER on post-trauma day #3. Emergent fasciotomy was done but distal perfusion did not recover. Cardio-vascular surgeon was consulted for arterial bypass. However, distal limb did not become warm and pink immediately. We kept medication for vessel patency and anticoagulation. Fortunately, distal perfusion recovered gradually after several days. But partial muscle and fascia necrosis resulted in bone exposure. Serial debridement and sequestrectomy were done. Finally, we applied Negative Pressure Wound Therapy (NPWT) then STSG eventually closed the wound.

Result: We followed up his wound condition for one year, his wound healed well and there was no recurrence of infection or necrosis. Ambulation is regained without aid of prosthesis or cruches despite of mild foot-drop.

Conclusion: Clinicians should be cautious to unusual manifestations of blunt trauma, which may signalize a concomitant vascular injury. Early detection and re-perfusion as soon as possible are very important and encouraged for successful limb salvage.

Keywords: Limb salvage; Artery transection; Limb blunt trauma; Arerial by pass


Popliteal artery injury is an uncommon situation encounterd in lower limb trauma. Delay in diagnosis and treatment could increase morbidity and eventually result in a diaster. Popliteal artery was anatomically surrounded by the politeal ligamentous, femur bone, tibial plateau, and knee joint capsule thus susceptible to highenergy blunt and penetrating trauma [1]. The association between popliteal artery injury and tibiofemoral dislocations as well as femur fractures has been widely discussed in literatures [2,3]. Initial physical exams characteristically show marked knee joint instability, and roentgenogram revealed fractures, subluxations and soft tissue swelling [4].

Reviewed literatures about popliteal artery injury caused by trauma have described intimal tears, dissection, ruptures, or even transection of the popliteal artery upon surgical exploration [5]. We present a unique case of a delay-diagnosed complete left popliteal artery transection following a motorcycle collision, without obvious associated fracture or evidence of a tibiofemoral dislocation.

Case Report

This patient was a 31-year-old male suffered from acute left lower limb blunt trauma in a traffic accident which mechenism was falling down from ridding motorcycle and hitting a telephone pole. He was sent to our ER (emergency room) by EMT (Emergency Medical Technician). The Glasgow Coma Score was 15 at the scene, no requiring of intubation. The systolic blood pressure was 122mmHg while the diastolic blood pressure was 68 mmHg, and the heart rate was 120 beats per minute. CT (Computed Tomography) of brain and focused assessment with sonography for trauma yieled negative results.

On physical examination, the left lower extremity was swollen and tense, but distal pulses were ausculated by sonogram. Radiographs of the left femur and left knee demonstrated no evidence of fracture or dislocation. Due to left lower limb pain complained by the patient, he stayed in our ER for 7 hours observation then was discharged. Symptoms and signs of vessel injury were not detected at that moment.

However, he came back to our ER 3 days later because of progressive swelling and pain of his left lower limb with large area of ecchymosis occured after his working (Figure 1). At this moment, labratory data showed Myoglobin was 5437 ng/mL whereas CK (creatine kinase) -total was 31903 U/L. Distal perfusion of left lower leg and foot was absent. Due to clinical evidence of left lower extremity compartment syndrome with rhabdomyolysis, the patient was taken to the operating room immediately for emergent fasciotomy to release pressure. However, after we released all compartment of left lower leg, distal perfusion did not recover at this moment.