Reconstrucción de la fosa poplítea con colgajo fasciocutáneo de la arteria safena / Reconstruction of the popliteal fossa with fasciocutaneous flap of the saphenous artery

INTRODUCCIÓN. Los defectos de la fosa poplítea suponen un desafío reconstructivo para el cirujano plástico, dada la relación íntima de esta área con la articulación de la rodilla y la neurovasculatura vital subyacente. El propósito de éste informe fie compartir la experiencia en la utilización de un colgajo fasciocutaneode la arteria safena. CASO CLÍNICO. Paciente de 5 años de edad que sufrió quemadura térmica en miembros inferiores con dos años y medio de evolución, ameritó injertos, presentó contractura por tejido cicatricial en fosa poplítea, dificultó la deambulación y desarrollo neuro osteomuscular. Se realizó reconstrucción de la fosa poplítea con colgajo fasciocutáneo de la arteria safena. RESULTADOS. El colgajo fasciocutáneo de la arteria safena dio cobertura al defecto en fosa poplítea izquierda tras retiro del tejido cicatricial que producía contractura, limitaba la marcha y el desarrollo neuro osteo-muscular. Seis meses postquirúrgicos brindó cobertura cutánea definitiva y estable en el área crítica, que permitió la deambulación con movimientos de extensión y flexión de rodilla conservados. DISCUSIÓN. Este colgajo al igual que en otros estudios que respaldan su ejecución brindó excelentes resultados en defectos de partes blandas a nivel de la articulación de la rodilla. CONCLUSIÓN. El colgajo fasciocutáneo de la arteria safena demostró utilidad para la reconstrucción del defecto de la fosa poplítea, posibilitó una cobertura definitiva, funcional y estética, restableció los ángulos de movilidad y favoreció el desarrollo pondoestatural del paciente.

INTRODUCTION. Defects of the popliteal fossa pose a reconstructive challenge for the plastic surgeon, because of the intimate relation of this area with the knee joint and the near vital neurovasculature; the purpose of this report was to share the experience of using a fasciocutaneous flap of the saphenous artery. CLINICAL CASE. A 5 year old patient who suffered thermal burn in lower limbs with two and a half years of evolution, he nedeed grafts and presented tissue contracture because the scar in the popliteal fossa hindered ambulation and neuro-osteomuscular growth. Reconstruction of the popliteal fossa was made it with a fasciocutaneous flap of the saphenous artery. RESULTS. The fasciocutaneous flap of the saphenous artery covered the defect in the left popliteal fossa after removal of the scar tissue that caused contracture, limited to walk and growth. Six months after surgery the flap provided definitive and secure skin coverage in the critical area, which allowed to walk with preserved knee extension and flexion movements. DISCUSSION. This flap was useful for the recons-truction of the defect of the popliteal fossa and provided excellent results in soft tissue defects in this area of the knee joint. CONCLUSION. The fasciocutaneous flap of the saphenous artery proved useful for the reconstruction of the popliteal fossa defect, it permited a definitive, functional and esthetic coverage, reestablished the angles of mobility and helped with the patient growth

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

Background: Lower extremity arterial injuries caused by penetrating or fired-gun trauma may result in limb or loss of life. Early intervention has critical importance. The aim of this study was to investigate the importance of early intervention and outcomes.Methods: We retrospectively reviewed the data on 144 patients (18 females, 126 males) who were treated in Istanbul Medipol University Hospital between January 2016 to 2018. All patients had an arterial injury at level of femoral and popliteal arteries. Standard statistical methods were used for data analysis.Results: Revascularization was performed to all 144 (18 females, 126 males) patients. Autologous saphenous vein graft interposition was performed in 96 patients. End-to-end repair was performed in 39 patients. 9 patients underwent a polytetrafluoroethylene graft (8 mm ringed) interposition.Conclusions: All viable limbs should be revascularized rapidly. The primary goal is to provide bleeding control rapidly and to prevent the prolongation of ischemic time. It should be kept in mind that in addition to surgical technique, fasciotomy may be required in arterial injuries with ischemic time of more than 6-8 hours.

Analysis and characterization of the normal gait phases of walking Warmblood horses as a tool for the diagnosis of lameness / Análise e caracterização das fases do andamento normal dos cavalos através da combinação de fotogrametria e acelerometria como ferramenta para o diagnóstico da claudicação

Horses with lameness modify gait behavior, but when it is subtle, it may not be possible to identify it clinically. The objective of this research is to characterize the normal gait phases of walking Warmblood horses by combining photogrammetry and accelerometry to monitor lameness to indicate a structural or functional disorder in the extremities. The study was conducted in 23 adult male Warmblood horses. Photogrammetry was used to identify the kinematic variables of the limbs and the markers path over time; triaxial accelerometers were used to capture the orthogonal acceleration components. It was determined that only 10 horses showed a normal gait pattern, there was a 43% correspondence between the expert´s judgment and the diagnostic techniques. According to the Stashak classification of the gait phases, cycle phases to forelimb were 34/4/8/13/41, while for hind limb were 54/11/8/8/19 (% of the stride). The range of motion (ROM) of the neck, knee and fetlock joints was 45.52±5.63°, 196.04±19.7° and 209±11.52° respectively. A combination of experimental methods was used to identify the phases of gait cycle of healthy horses. There was a correspondence in the location of the points of maximum displacement of the limbs with both techniques. More detailed information on the limbs movement was obtained using the accelerometer technology. These methods are applicable to other conditions either outdoors or in the lab.(AU)

Os cavalos com claudicação modificam o comportamento do andamento. Porém, uma leve modificação pode não ser identificada clinicamente. O objetivo desta pesquisa foi caracterizar as fases do andamento normal dos cavalos através da combinação de fotogrametria e acelerometria, para identificar alterações estruturais ou funcionais nos membros. O estudo foi conduzido em 23 cavalos Warmblood machos adultos. A partir da fotogrametria foi possível obter as variáveis cinemáticas das extremidades e a trajetória dos marcadores ao longo do tempo. Por outro lado, os acelerômetros triaxiais foram usados para capturar as componentes ortogonais da aceleração. Determinou-se que apenas 10 cavalos mostraram um padrão de marcha normal, e houve uma correspondência de 43% entre pareceres dos peritos e as técnicas de diagnóstico. De acordo com a classificação das fases da marcha de Stashak, as fases do ciclo da extremidade anterior foram 34/4/8/13/41 enquanto para a extremidade posterior foram 54/11/8/8/19. A amplitude de movimento (ROM) de pescoço, joelho e sesamóide foram 45,52±5,63°, 196,04±19,7° e 209±11,52°, respectivamente. Uma combinação dos métodos experimentais foi utilizada para identificar as fases do ciclo de marcha de cavalos saudáveis. Constatou-se correspondência na localização dos pontos de deslocamento máximo do membro com ambas as técnicas. A informação mais detalhada do movimento dos membros foi obtida usando a acelerometria. Estes métodos são aplicáveis em outras condições, quer a campo ou no laboratório.(AU)

Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries.

Introduction: Limb injuries by sharp objects commonly result in tendon or neurovascular damage. The aim of this study is (1) to determine the incidence of significant neurological, musculotendinous or vascular injury; (2) to explore the cause of such wounds; (3) to determine the incidence of missed injuries; and (4) to assess the prognosis of neurological, vascular and musculotendinous injuries. Methods: Fifty eight adult patients were evaluated in the Emergency Department of our institution for incised wounds sustained to upper and lower extremities. Major trauma with obvious musculotendinous, vascular and neurological injuries was excluded. An injury was characterized as being missed if a patient had received inappropriate treatment or had returned due to persistent symptoms despite being examined, treated and discharged. Only wounds of less than 24 hours duration were included. Non-accidental injuries were excluded. Results: Fifty one (89%) patients sustained upper extremity wounds while only seven (11%) sustained injuries to the lower limb. Neurovascular and tendon injuries occurred exclusively in the upper limb. Twenty one (36%) patients sustained tendon, nerve and/or vascular injuries (41.2%). Glass injury was found to be the most common cause (41.3%) followed by Knife injuries (15.5%). Fifteen patients were offered an admission to hospital by the Trauma service for definitive treatment. Four of these patients signed DAMA (Discharge against Medical Advice). Six patients did not warrant admission and were discharged from the Emergency Department following appropriate treatment. Thirty seven patients were treated by Emergency Physicians and subsequently discharged. A missed tendon injury was reported in one patient (1.7%). Conclusion: A thorough clinical examination and accurate injury documentation in the Emergency Department is fundamental in recognizing tendon injuries.