One Leg Good, Two Legs Better: The Tricky Trifurcation
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A complex popliteal trifurcation injury forces the surgeon to make decisions where anatomy, physiology, time and the patient’s future function all compete for priority.
Jonathan Morrison uses a penetrating lower-extremity trauma case to build a practical framework for limb salvage: restoring perfusion rapidly, choosing vascular targets, preserving collateral circulation, coordinating bony stabilization and soft-tissue coverage, and knowing when damage-control reconstruction is more appropriate than an immediate definitive repair.
The lecture also challenges familiar assumptions. Morrison discusses why the MESS score has become less useful as a stand-alone predictor, how social support can influence long-term outcomes, what intraoperative angiography reveals beyond vessel continuity, and why a technically salvaged limb is not automatically a successful salvage.
The discussion moves into military trauma, high-energy mechanisms, shunting, conduit size mismatch, fasciotomy strategy and unconventional approaches to revascularization. Throughout, the central question remains deliberately uncomfortable: what does meaningful limb salvage actually mean for this patient?
Jonathan Morrison uses a penetrating lower-extremity trauma case to build a practical framework for limb salvage: restoring perfusion rapidly, choosing vascular targets, preserving collateral circulation, coordinating bony stabilization and soft-tissue coverage, and knowing when damage-control reconstruction is more appropriate than an immediate definitive repair.
The lecture also challenges familiar assumptions. Morrison discusses why the MESS score has become less useful as a stand-alone predictor, how social support can influence long-term outcomes, what intraoperative angiography reveals beyond vessel continuity, and why a technically salvaged limb is not automatically a successful salvage.
The discussion moves into military trauma, high-energy mechanisms, shunting, conduit size mismatch, fasciotomy strategy and unconventional approaches to revascularization. Throughout, the central question remains deliberately uncomfortable: what does meaningful limb salvage actually mean for this patient?
TRAUMA-02
Course
Vascular Trauma and Perfusion Control in Combat Injuries
01
58:38
Ballistic Vascular Injury Management: Hemorrhage Control, Shunts and Limb SalvageProfessor David Hampton of the University of Chicago breaks down the management of ballistic vascular injuries—from hemorrhage control and temporary shunting to fasciotomy, revascularization and definitive repair.
02
53:58 Now playing
One Leg Good, Two Legs Better: The Tricky TrifurcationJonathan Morrison explores one of trauma surgery’s hardest decisions: when a severely injured lower limb can be meaningfully salvaged, when amputation is safer, and why restoring perfusion is only the beginning.
03
1:17:48
Prolonged Tourniquets: Ischemia, Reperfusion and Compartment SyndromeWhat happens when a tourniquet stays on for hours? A practical combat-trauma lecture on limb ischemia, reperfusion injury, compartment syndrome and fasciotomy, combining military evidence with lessons emerging from Ukrainian experience.
04
49:30
EVTM in Trauma: Early Vascular Access, REBOA and Hybrid Hemorrhage ControlA practical overview of Endovascular Resuscitation and Trauma Management (EVTM), from early femoral access and REBOA to embolization, stent grafting and hybrid surgery in critically unstable patients.
05
1:15:30
Endovascular Management of Blast-Related Head and Neck Vascular InjuriesA case-driven lecture on diagnosing and treating complex head and neck vascular injuries after blast and penetrating trauma, based on frontline military hospital experience.
06
1:09:35
Surgical Management of Carotid Artery InjuriesA practical lecture on carotid artery injuries in combat trauma: surgical exposure, damage-control decisions, temporary shunting, ligation, reconstruction, stroke prevention, and the realities of care across Role 2–4.
One Leg Good, Two Legs Better: The Tricky Trifurcation