Popliteal artery rupture with closed degloving injury: A case report: Popliteal artery rupture with closed degloving injury

Gede Ridho Anandya Prasetya; Muhammad Ali Shodiq

doi:10.28982/josam.8466

Authors

Gede Ridho Anandya Prasetya Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia https://orcid.org/0009-0003-9624-7867
Muhammad Ali Shodiq Department of Surgery, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia https://orcid.org/0009-0006-1880-5474

DOI:

https://doi.org/10.28982/josam.8466

Keywords:

closed deglove, popliteal artery rupture, Morel-Lavallée lesion, arteriography, irreversible ischemia, amputation

Abstract

Popliteal artery rupture is a rare but limb-threatening vascular injury, particularly when it occurs with a Morel-Lavallée lesion (closed degloving injury). The concurrent presence of complete arterial disruption and extensive soft-tissue damage substantially increases the risk of irreversible distal ischemia and amputation, especially when definitive intervention is delayed beyond the critical six-hour ischemic threshold. We report the case of a 29-year-old man who presented after a high-energy traffic accident with hemodynamic instability, absent distal arterial pulsation, and extensive subcutaneous fluctuation extending from the right thigh to the medial knee. Initial radiologic assessment revealed no fracture. Arteriography of the right femoral artery confirmed complete rupture of the right popliteal artery with nonvisualization of the posterior tibial, peroneal, and distal anterior tibial arteries beyond the injury site. Arteriographic delineation of the vascular occlusion level was used to determine the optimal amputation level. The patient underwent fluid resuscitation, transfusion of three units of whole blood, intravenous heparin therapy, surgical drainage of the closed degloving cavity, and primary amputation of the right lower extremity. Amputation was required because delayed presentation beyond the golden period had resulted in irreversible ischemia. He was discharged in stable condition after five days of hospitalization. This case underscores the need for early recognition and timely intervention in popliteal artery injuries. Delay beyond the ischemic threshold substantially increases the risk of amputation. A multidisciplinary approach and awareness of the narrow window for limb salvage are essential in complex lower extremity trauma.

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