Injury to the calf arteries

　　Most lower limb arterial injuries are caused by tibiofibular fractures (with the upper end of the tibia being more common), followed by external violence, including sharp puncture wounds, lower limb crush injuries, etc. The injury to the tibiofibular trunk caused by the fracture of the upper end of the tibia is the main cause of acute ischemic contracture of the lower limb. The vascular injury caused by comminuted fractures of the lower limb is extensive, affecting not only arteries but also the venous system.

　　Lower limb arterial injury often leads to lower limb muscle fascicle syndrome. Lower limb muscle fascicle syndrome refers to the disease caused by the obstruction of blood circulation due to the increased pressure in the compartments surrounded by bone, perimysium, interosseous membrane, and muscle fascicle, for various reasons, leading to necrosis of muscle tissue, tendons, and nerve tissue, and functional disorders.

　　The clinical manifestations of lower limb arterial injury mainly include the following several aspects:

　　1. Decreased or absent pulse of the dorsalis pedis artery

　　The decreased or absent pulse of the dorsalis pedis artery is a common symptom of lower limb arterial injury.

　　2. Severe traumatic response of the lower limb

　　In addition to the direct puncture injury of sharp objects, the violence that can cause lower limb arterial trunk injury is generally strong, so the resulting fractures and soft tissue injuries are also more obvious, and the traumatic response is also more severe. In addition, there are many muscle fascicles in the lower limb, which are prone to worsen the condition due to poor drainage.

　　3. The occurrence of lower limb muscle fascicle syndrome is likely

　　In addition to the violent factors, the spasm and obstruction after arterial injury not only directly cause ischemic changes in muscles and nerve branches, but also also exacerbate the high-pressure state in the muscle fascicle. Therefore, the incidence of lower limb muscle fascicle syndrome is relatively high.

　　4. Other symptoms

　　Local pulsatile hematoma and fresh blood effusion (spurt) are characteristic symptoms and signs of arterial injury, which should be carefully observed and judged.

　　The incidence of lower limb necrosis in patients with obstruction of the tibiofibular trunk or two arteries can reach 15% to 20%; when all three lower limb arteries are obstructed, the incidence of necrosis can reach 50%. Therefore, for lower limb arterial injuries, it is strive to reconstruct the arterial blood supply function within 6 hours after the injury. In prevention, attention should be paid to avoid various factors that may cause injury.

　　The auxiliary examinations for lower limb arterial injuries mainly include the following:

　　1. Ultrasound

　　Ultrasound can roughly understand the condition of lower limb arterial injury, and can detect secondary thrombosis, pseudo-aneurysms, and the presence of arteriovenous fistulas, etc.

　　2. X-ray

　　X-ray can clearly determine whether there is a fracture of the tibia and fibula.

　　3. Arteriography

　　Arteriography can clearly identify the location of lower limb arterial injury.

　　Patients with lower limb arterial injuries should eat more blood-building foods such as animal livers and eat more high-protein foods and vegetables and fruits. In addition, patients should pay attention not to eat spicy, greasy, or fishy foods.

　　Simple lower limb arterial injuries are easier to treat, but complex arterial injuries with bone and joint injuries and compartment syndrome are more difficult to treat, and the therapeutic effect is often not ideal. Therefore, the following points should be noted in treatment:

　　1. Arterial injury should be operated on as soon as possible

　　In a sense, lower limb arterial injury is more complex to deal with than femoral artery injury, so it is imperative to make an early diagnosis and perform reconstruction surgery before complications (especially compartment syndrome) occur.

　　2. For those who are difficult to diagnose with arterial injury, exploratory surgery should be performed

　　While actively preparing for surgery, it is necessary to prepare for intraoperative arteriography. Generally, on the operating table, 10-20ml of angiographic agent is injected through a puncture in the femoral artery, which can show the condition of the injured lower limb artery and serve as a basis for further treatment.

　　3. For complex, especially destructive lower limb injuries, a comprehensive consideration should be made, including amputation

　　For lower limb injuries caused by serious traffic accidents or mining collapses, the decision on whether to retain the injured limb should be based on the patient's overall condition and the possibility of limb survival.

　　4. Timely prevention and treatment of the peroneal compartment syndrome

　　While dealing with vascular injuries, attention should also be paid to the treatment of bones, joints, and soft tissues. Strive to deal with them before irreversible pathological changes occur, in order to prevent problems before they arise.

　　5. Management of complications of late vascular injury

　　All lesions that affect the blood supply to the distal extremities should be resected and the normal anatomical state and physiological function of the artery should be reconstructed.