Artikel
Ultra low velocity trauma - vascular injury in obese patients
Suche in Medline nach
Autoren
-
Ismael Fuchs
- LKH Bruck/Mur, Österreich, Gefäßchirurgie, Bruck/Mur
-
Thomas Allmayer
- LKH Bruck/Mur, Österreich, Gefäßchirurgie, Bruck/Mur
-
Franz Schweighofer
- LKH Bruck/Mur, Österreich, Unfallchirurgie, Bruck/Mur
-
Josef Tauss
- LKH Bruck/Mur, Österreich, Radiologie, Bruck/Mur
-
Manfred Wonisch
- Hansa Sanatorium Graz, Innere Medizin, Graz
-
Gerald Seinost
- Medizinische Universität Graz, Angiologie, Graz
-
Manuela Jaindl
- AKH Wien, Unfallchirurgie, Wien
-
Florian M. Kovar
- AKH Wien, Unfallchirurgie, Wien
| Veröffentlicht: | 26. April 2013 |
|---|
Gliederung
Text
Introduction: Vascular injury after knee dislocation is a relatively rare serious, potentially-limb-threatening injury that may result in significant long-term functional disability. In our case series of two female patients vascular injury occurred after an ultra low velocity trauma in the domestic home. Due to the fact of imminent diagnosis and surgical treatment, limb loss was observed in one patient.
Material and methods: Case 1: A 72-year old female, BMI 28 kg/m2, with diabetes mellitus Type II, arterial hypertonia, obesity in her past medical history was admitted on an outpatient basis due to acute ischemia of the lower limb following ultra-low-velocity trauma after knee dislocation.
Case 2: A 57-year old female, BMI 44 kg/m2, with diabetes mellitus Type II, psychosis, obesity in her past medical history was admitted on an outpatient basis due to acute ischemia of the lower limb following ultra-low-velocity trauma after knee dislocation.
Results: Case 1: Intraoperative finding was a stenosis at the crossover between SFA (superficial femoral artery) and popliteal artery due to an arteriosclerotic plaque. The major saphenus vein was harvested contra lateral and implemented in end-to-end technique. After the total time of surgery of four hours, peripheral vascularization was normal, tissue color comparable to the uninjured contra lateral side.
Case 2: The major saphenus vein was harvested contra lateral in a distance of 40 cm and implemented in end-to-end technique. Proximal docking site of the graft was the SFA, the distal anastomosis was connected at the III segment of the popliteal artery at the outlet of the anterior tibial artery, showing dry anastomosis and a palpable dorsalis pedis artery after flushing.
Conclusion: The fact of adverse outcomes, even in this very rare diagnosis, should increase our awareness in obese patients with knee pain after seemingly ultra-low-velocity trauma. X-rays, and if suspicion is raised, CT-scan lead to a detailed and profound diagnosis, enabling immediate surgical intervention to save the affected limb.
