Incidence and outcome of pulmonary embolism following popliteal venous repair in trauma cases.

OBJECTIVES AND DESIGN: Popliteal vein repair and ligation are the two main approaches to the treatment of the venous component of major, complex, knee injuries with vascular involvement. We have studied the incidence of pulmonary embolism following popliteal vein repair in trauma cases using computed tomography (CT) angiography and report the outcome. MATERIAL AND METHODS: From June 2006 to December 2009, 45 patients with popliteal vein injury were operated on in our vascular unit using lateral venorrhaphy, end-to-end anastomosis, a saphenous vein interposition graft and venous patch repair. All the patients were operated on using a medial approach to the knee. On the third postoperative day, all patients underwent a colour Doppler scan of the repaired popliteal vein to study patency, and pulmonary artery CT angiography using a 64-slice multidetector CT scan unit to establish the incidence of pulmonary embolism. RESULTS: The number of patients treated by each method were: lateral venorrhaphy 20 (44%), end-to-end anastomosis 13 (29%), saphenous vein interposition graft 9 (20%) and venous patch repair three (7%). Two patients (4%) died because of sudden cardio-respiratory arrest the day after surgery with massive bilateral pulmonary artery embolism at autopsy. Popliteal colour duplex ultrasound imaging showed seven (16%) cases of complete vein thrombosis and seven (16%) cases of partial vein thrombosis. CT angiography showed pulmonary embolism in 11 (26%) patients. From seven patients with complete thrombosis three patients, and from seven patients with incomplete thrombosis five patients showed pulmonary embolism on CT angiography. Other than two cases of early mortality, five (12%) patients developed clinical manifestations of pulmonary embolism and 11 (26%) patients had pulmonary embolism detected by CT angiography. Seven (16%) of our patients had mild-to-severe pulmonary embolism and 13 patients (29%) had proven pulmonary embolism. The total mortality rate was 7%. CONCLUSION: A surprisingly high incidence of pulmonary embolism was observed after popliteal vein repair in civil trauma patients. Additional prophylactic methods such as using higher doses of heparin and using inferior vena cava (IVC) filters might be needed to prevent this potentially fatal complication.

Use of vein graft as a tendon sheath substitute following tendon repair: an innovative technique in tendon surgery.

OBJECTIVES: This is a new technique for managing tendon repair that may improve the results of existing methods. METHODS: In a prospective randomized clinical trial, 210 patients were divided into two groups of test and control. All patients had flexor tendon injuries, involving zone 2. They were new or old tendon injuries or complications of previous repairs. In the test group (105 patients), a modified Kessler repairing of tendons with 3-0 prolene was used, followed by a core suture of running 6-0 nylon or prolene epitendinous suture. After the tendon repair, a segment of vein through which the tendon had been passed before or a patch of vein, as a tendon sheath substitute, was used to repair the sheath defects. The results in a span of six months of follow-up were compared with those of the control group whereon 105 patients were operated under the conventional technique--the modified Kessler method. RESULTS: We assessed the results by measuring the range of motion of the MCP joint in the follow-up period and we graded them as excellent, good, fair and poor. In the test group we had 86% excellent, 11% good, 3% fair and 0% poor results, and in the control group, 0% excellent, 12% good, 38% fair and 50% poor results. The differences were significant (p<0.005). CONCLUSIONS: Our preliminary results appeared encouraging when compared with the outcomes achieved by the conventional tendon repair technique. As this technique reduces the adhesion formation, improves tendon nourishment, and decreases the need of intensive physiotherapy, it may substitute the conventional one and become a standard technique in the future.