Evidence based management of popliteal vessel injuries: A critical review, updates and controversies in the management of a difficult injury.

Abstract

Popliteal artery injuries are rare even in urban Trauma Centers. The vast majority occur secondary to penetrating trauma. These injuries are uncommon; therefore, few Trauma Surgeons and Trauma Centers have developed significant experience with their management. Experiences reported in both military and civilian publications consistently report the highest complications and amputation rates of all vascular injuries due to popliteal vessel injuries. The popliteal artery is an end artery. Injuries cause significant ischemia that significantly threaten limb viability. The popliteal vein provides the main outflow from the calf musculature. Repair is preferred to preserve venous outflow in the injured limb. Popliteal vessel injuries require excellent surgical technique to repair and restore blood flow in a timely fashion, prioritizing operative efficiency to decrease ischemia, preserve limbs and avoid amputations. These factors are of the utmost importance to achieve excellent results. Past and recent military conflicts have provided Trauma Surgeons with experiences to develop protocols to manage these injuries, most importantly experiences from the Vietnam conflict. If there are any lessons to be learned from the recent conflicts in Iraq, Afghanistan, and currently Ukraine; is that Trauma Surgeons must be well trained to rapidly deal and effectively repair these injuries. We have endeavored to provide updates and explore current controversies, but most important is the call to formulate a comprehensive surgical plan to adequately train competent Trauma, Vascular, and General Surgery residents to deal with vascular injuries, given the current controversies as to which surgical specialists should deal with these injuries. How will the field of academic surgery proceed to train future generations of surgeons? This remains an unknown.