Popliteal vasküler yaralanmalara yaklaşım

Amaç: Popliteal vasküler yaralanmalar, periferik vasküler yaralanmalar içerisinde ekstremite hayatiyetini en fazla tehdit eden yaralanmalar olarak bilinir. Bu çalışmanın amacı, popliteal vasküler yaralanma nedeniyle cerrahi uyguladığımız hastalara yaklaşımımızı değerlendirmektir. Yöntem: Eylül 2001 ile Ekim 2009 tarihleri arasında kliniğimizde popliteal vasküler cerrahi uygulanan 10 hasta değerlendirilmiştir. Hastaların 3’ü kadın, diğerleri erkektir. Yaş ortalaması 29,3 ± 13,7’dir. Beş hastada yaralanma ateşli silaha, 3 hastada künt travmaya ve 2 hastada kesici delici aletle yaralanmaya bağlıdır. Altı hastaya otolog safen ven greft, 2 hastaya uç uca anastomoz ve 2 hastaya primer tamir yoluyla vasküler rekonstrüksiyon yapılmıştır. Bulgular: Üç hastaya fasiotomi gereksinimi olmuştur. Başarılı revaskülarizasyona rağmen, 2 hastaya yara yeri sorunlarına bağlı diz altı amputasyon uygulanmıştır. Sonuç: Ekstremitenin kurtarılabilmesi, erken tanı konulması, erken cerrahi girişim yapılması, venöz yaralanmaların tamiri, kemik fraktürlerinin fiksasyonu ve fasiotomiden kaçınılmaması ile ilişkilidir.

Approach to popliteal vascular injuries

Objective: Injury to the popliteal vessels has been recognized as the most limbs threatening of peripheral vascular injuries. The purpose of this study was to evaluate our management strategy on patients who were applied popliteal vascular surgery for popliteal vascular injuries. Methods: From September 2001 to October 2009, 10 patients who had popliteal vascular surgery were evaluated for our management strategy. Seven of them were male, 3 were female. The average age of the patients was 29,3 ± 13,7 years. The mechanism of injury was gunshot in 5 patients, blunt trauma in 3 patients and stab wound in 2 patients. Vascular reconstruction was achieved by using an autogenous saphenous vein graft in 6 patients, end to end anastomosis in 2 patients and primarily in 2 patients. Results: Three patients required fasciotomy. Two patients had subsequent below knee amputation, because of wound complication despite successful revascularisation. Conclusion: The limb salvage is associated with rapid diagnosis, early surgical treatment, repairing venous injuries, fixation of bone fractures and applying fasciotomy without hesitating.

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