OBJECTIVE: To evaluate the rate of salvage of lower limb with long-time injury of popliteal artery. METHODS: Twenty-one patients with injury of popliteal artery were treated. The interval between injury and repair of artery ranged from 12 hrs to 48 hrs. The essences of operation were thorough debridement of the ischemic and necrotic muscles, primary suture of wound, and repair of popliteal artery on the basis of reduction and fixation of fracture. RESULTS: The limb salvage were achieved in 19 cases. The saved limbs could fulfill the basic function of walk. CONCLUSION: Thorough debridement of ischemic and necrotic muscle and primary suture of wound were reasonable methods which could treat long-time injury of popliteal artery without amputation.
Objective To summarize the experience in treatment and diagnosis of popliteal artery trauma and to determine the factors for amputation. Methods From February 1995 to January 2006, 28 patients with popliteal artery trauma were treated. The disease course was more than 8 hours. Of them, there were 25 males and 3 females, aging from 3 to 53 years. Trauma was caused by traffic accident in 12 cases, by falling from height in 3 cases, by firearm in 2 cases, by sharp instruments in 3 cases, by strangulation in 2 cases and by others in 6 cases. No arteriopalmus or weak arteriopalmus wereobserved in 18 cases and in 8 cases respectively. Popliteal artery exposure or active bleeding was seen in 2 cases; the popliteal arteries were examined by operation in 8 cases; color ultrasound Doppler flow imaging showed color flood flowsignals were through popliteal artery and its branches in 20 cases. Defect sizeof popliteal artery was less than 5 cm in 7 cases and more than 5 cm in 9 cases. End to end anastomosis reconstruction by saphenous vein graft and direct suture was performed in 16 cases and ampulation in 12 cases. The time of the revascularization of the leg was 8-150 hours (mean 31.8 hours). Results All patients were followed up 6 months to 11 years with an average of 4.2 years. In 16 cases given end to end anastomosis reconstruction, 15 cases achieved revascularization and limb survival; lower limb function restored to normal within 1 year in 12 cases; foot drop and ankle joint contracture occurred in 3 casesand the survival rate of limbs was 94%. Amputation was given in 12 of 28 casesbecause of severe trauma. The rate of amputation was 43% and the rate of disability was 54%. Conclusion Popliteal artery trauma should be treated as soon as the diagnosis is made. If the revascularization is more than 8 hours or circulatory compensation is not complete, it will affect the leg survival. Delayed diagnosis and severe traumas are the cause of high rate ofamputation in popliteal artery trauma.
ObjectiveTo summarize experience of diagnosis and surgical treatment of popliteal artery entrapment syndrome (PAES).MethodThe clinical data of 10 patients (10 limbs) with PAES underwent surgery in the China-Japan Hospital of Jilin University from January 2012 to July 2018 were retrospectively analyzed.ResultsAmong 10 cases of PAES, 7 cases were firstly diagnosed with the intermittent claudication, 3 cases had presented the acute lower extremity ischemia. The preoperative ultrasound and (or) computed tomography angiography showed that 9 cases were all the popliteal artery occlusion and the digital subtraction angiography (DSA) was performed in 1 patient after the admission for the treatment. Six patients were preoperatively diagnosed with the PAES. Seven cases were treated with the autologous saphenous vein interstitial bypass; 1 case was occluded on day 3 after the popliteal artery thrombectomy, then the reconstruct of femoral popliteal artery was performed after the exploration and diagnosis. One case directly received the catheter thrombolysis and balloon dilatation during the process of DSA examination, the effect was not good, then the muscular bundle resection and popliteal artery artificial patch plasty was performed after confirming the PAES. All the 10 cases were followed up by the color doppler ultrasound after the surgery, 1 patient underwent the saphenous vein graft reconstruction (distal anastomotic anastomosis) was obliterated on month 1 after the surgery, 1 case was occluded on month 3 after the popliteal artery reconstruction, the patency rate of the remaining 8 patients was 100% from 3-month to 1-year of following-up. ConclusionSurgical treatment is an only effective radical treatment of PAES and its patency rate of total occlusive lesions with autogenous saphenous vein graft is higher.
Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.
ObjectiveTo investigate the feasibility and effectiveness of free popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein for the repair of wound on the foot and ankle by anatomical observation and clinical application. MethodsLatex was poured into the blood vessels of 8 cadavers, then perforator vessel of posterolateral upper calf was dissected, and the popliteal artery cutaneous branch flap was designed with a pedicle of 2.5 cm in length; the lateral tarsal artery of the foot was dissected, could be freed to 6 cm in length; the diameter of these vessels was measured, and the number of the accompanying veins was counted. Between March 2010 and January 2013, 13 cases of foot and ankle wounds were repaired with popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein. The size of flaps ranged from 6.0 cm×4.0 cm to 7.5 cm×5.5 cm. There were 11 males and 2 females, aged from 41 to 65 years (mean, 47.3 years). The causes of injury included traffic accident in 8 cases, crushing in 4 cases, and twist by machine in 1 case. The size of wounds, ranged from 5.0 cm×3.5 cm to 7.0 cm×5.0 cm. The donor sites were sutured directly. ResultsAccording to anatomical observation, the popliteal artery cutaneous branch flap was designed by using the lateral popliteal artery perforator for shaft. The vessel of the pedicle perforator flaps from the popliteal artery cutaneous branch flap matched well with the lateral tarsal artery. Clinical results: vascular crisis occurred in 2 flaps, which survived after symptomatic treatment; the other flaps survived, with primary healing of wound and incision at donor site. The patients were all followed up 5-18 months (mean, 11 months). The flap had normal color and good elasticity. Second stage operation was performed to make the flap thinner in 3 female patients because of bulky flaps. The remaining patients had no obvious fat flap. According to American Orthopaedic Foot and Ankle Society (AOFAS) score for evaluation of the ankle function at 6 months after operation, the results were excellent in 7 cases, good in 5 cases, and fair in 1 case, with an excellent and good rate of 92.3%. ConclusionFree popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein for the repair of wound on the foot and ankle is simple and effective. The donor site is hidden.