Optimal management of tibial arterial trauma

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Shah DM. Corson JD. Karmody AM. Fortune JB. Leather RP. Journal of Trauma. [JC:kaf] 28(2):228-34, 1988 Feb. To define optimal management, the outcome was studied of 29 isolated tibial *arterial* injuries treated during the past 4 years. Twenty-five patients sustained blunt *trauma* and 4 had penetrating *trauma.* Twenty-seven patients had preoperative arteriography, which demonstrated at least 1 interrupted tibial artery. In 9 patients immediate reconstruction was done successfully. Because the foot was viable in 20 patients, immediate reconstruction was not performed despite the diagnosis of tibial *arterial* injury. Three patients had primary amputation. Fifteen of the remaining 17 patients required further angiographic assessment for *arterial* reconstructions 2-12 months later for nonhealing of wounds, malunion of fractures, and soft tissue defects. Generally, delayed reconstructions were more complex. Viable and functional feet were eventually achieved in 13 patients. Bypass with autogenous vein was mandatory for success. These results demonstrate that most tibial *arterial* *trauma* requires immediate repair for a successful outcome. Delayed repair was more difficult and was associated with substantial loss of limb. A policy of immediate tibial artery repair is a good one and will allow proficiency to develop when the tibial artery being repaired is essential to viability of the foot.