[Accompanying embolectomy and closed fasciotomy in the same session for the delayed arterial thromboembolic occlusions in lower extremity]. / Alt ekstremite gecikmis tromboembolik arteriyel tikanmalarda ayni seansta embolektomi ve kapali fasiyotomi beraberligi.

OBJECTIVE: We aimed to compare the postoperative complications in patient with acute lower extremity arterial occlusion who admitted in the late period in whom accompanying embolectomy and fasciotomy in the same session and fasciotomy following embolectomy were applied, because of development of compartment syndrome. METHODS: A total of 36 patients (13 female, 23 male) with acute lower extremity arterial occlusion, who admitted to our clinic at least 12 hours after onset of symptoms were enrolled to the study and investigated retrospectively. While embolectomy was performed in all cases, the cases in which mini fasciotomy was performed after development of compartment syndrome constitute the group 1 (n=21) and the ones in whom accompanying embolectomy and closed mini fasciotomy in the same session constitute the group 2 (n=15), groups were formed randomly. Groups were compared in regard of extremity amputation, renal failure, hypoesthesia in lower extremity, paresthesia in fingers in their clinical course. In statistical analysis t test, Chi-square test and Mann Whitney U test were used for comparison of groups, and a p<0.05 was considered as significant. RESULTS: While cardiac originating embolus was the most frequent etiologic factor, femoropopliteal artery was the most frequent involved area in both groups. Morbidity rates were 66.6% in group 1 and 13.3% in group 2 (p<0.002). Amputation below the knee was performed in two patients in group 1. CONCLUSION: In order to reduce the unfavorable effects of reperfusion injury, accompanying fasciotomy and embolectomy in the same session, may have an important role in decreasing the postoperative mortality rate in patients who admitted in the late stage of lower extremity acute arterial occlusions.

Preservation of anterior leaflet chordae with modified miki technique: how to do it.

During mitral valve replacement, total chordae preservation is very important for left ventricular functions. But leaving anterior leaflet and chordae may cause serious complications, such as left ventricular outflow tract obstruction and impairment in prosthetic valve functions. In this article, we present the anterior leaflet preservation technique by excising the central portion of the anterior leaflet. The rim of the leaflet tissue containing the marginal chordae was divided in two parts without destroying the chordae, and then the rim of leaflet tissue was sutured to the left atrium. This technique provided optimal chordae tension and improved avoidance of complications due to total chordae preservation, in mitral valve replacement operations.