Massive Thigh Injuries With Vascular Disruption

Twenty-five patients with extensive soft tissue injury and femoral-popliteal arterial disruption were treated over a four-year period. Injury was most often due to closerange shotgun blasts, and often involved adjacent structures. Of the patients, 72% were admitted in severe shock; all but one were successfully resuscitated. Three patients did well following primary above-knee amputation. The remaining 21 had primary vascular repair, and 14 survived with a viable limb. There were four secondary amputations and four postoperative deaths. Adverse factors affecting survival and limb salvage included inadequate debridement, primary wound closure, failure of the vascular repair, and omission or incomplete fasciotomy. Split-thickness porcine skin grafts were used as a biological dressing to cover an exposed vascular repair in four patients. Limb salvage was achieved in three of these.