Optimal management of tibial arterial trauma.

In an attempt to define optimal management, we have studied the outcome of 29 isolated tibial arterial injuries during the past 4 years. Twenty-five patients suffered blunt and four had penetrating trauma. Twenty-seven patients had preoperative arteriography which showed at least one interrupted tibial artery. In nine patients, immediate and successful reconstruction was done. Since the foot was viable in 20 patients, immediate reconstruction was not carried out in spite of the diagnosis of tibial arterial injury. Three of 20 underwent primary amputation. Fifteen of the remaining 17 patients required further angiographic evaluation for arterial reconstructions 2 to 12 months later for nonhealing of wounds, malunion of fractures, and soft-tissue defects. Delayed reconstructions were generally more complex. In 13 patients both viable and functional feet were eventually achieved. Bypass with autogenous vein was mandatory for success. Our experience has shown that most tibial arterial trauma will require immediate repair for success. Delayed repair was more difficult and was associated with substantial limb loss.