For a study, researchers sought to describe the connection between the length of limb ischemia and successful limb salvage. In the trauma literature, the 6-hour time limit for revascularization of an ischemic limb was often used; however, recent research indicated that this time limit should be lower. Therefore, a cohort study of military personnel from the UK and the US was carried out. Consecutive patients with damage to the iliac, femoral, or popliteal arteries who underwent revascularization surgery were included. The Kaplan-Meier method was used to evaluate the relationship between limb outcome and the length of limb ischemia. There were 122 patients (129 limbs) who suffered damage to the iliac (2.3%), femoral (56.6%), and popliteal (41.1%) artery systems. In total, 87 limbs (67.4%) could be successfully saved. In the case of ischemia lasting less than 1 hour, 86.0%, followed by 68.3%, 56.3%, 6.7%, and 6.7% in the case of ischemia lasting between 1 and 6 hours (P<0.0001). Shock increased the likelihood of unsuccessful limb salvage by more than twofold [hazard ratio=2.42 (95% CI: 1.27-4.62)]. Limb salvage is critically dependent on the duration of ischemia, with a 10% reduction in the probability of successful limb salvage for every hour of delay to revascularization. The presence of shock significantly worsened the relationship. Therefore, military trauma systems should prioritize rapid hemorrhage control and early limb revascularization within 1 hour of injury.
