[Injuries of the lower extremity with vascular lesions of the popliteal area. Management errors].

Lower extreemity injury complicated by limb-threatening vascular injuries of the popliteal artery present an infrequent but difficult management problem. In a retrospective study 37 consecutive patients with severely injured lower extremities after blunt trauma, all complicated by popliteal vascular injury, were evaluated. In 10 patients we found severe management errors: In 7 patients a delay in diagnosis of the vascular injury, in 3 patients with extensive bone and soft-tissue damage an inadequate stabilisation of the fracture. The optimal management of complex injury with associated vascular injuries requires a high index of suspicion and a treatment of all components of such an injury. The initial goals are the accurate diagnosis or exclusion of arterial injury, surgical debridement, adequate bony stabilization with minimal additional bone and soft-tissue trauma, revascularisation by interposition of a vein graft after resection of the damaged segment, immediate fascial decompression and early soft-tissue reconstruction.