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Case Report

Turk J Vasc Surg. 2019; 28(1): 46-50


Multidisciplinary approach in “pat pat” injuries: the role of vascular surgeon

Okay Güven Karaca, İlhan Mavioğlu, Mustafa Haluk Akbaş, Ayşegül Koç, Zekeriya Okan Karaduman, Ayşegül Kunt.




Abstract

In Turkey, farm machinery accidents are important factors for morbidity and mortality. In Western Black sea region, a specific farming tool
is used, called 'Pat Pat'. In our clinic, we operated two patients with multiple lower extremity injuries occurred due to Pat Pat machines.
First case had a right Gustilo-Anderson type IIIC open tibial fracture, anterior tibial artery disruption, and a left massive soft tissue defect
with popliteal nerve and artery disruption as determined by digital subtraction angiography. The second case had a right Gustilo-Anderson
type IV open proximal tibial fracture, distal femoral fracture, and popliteal artery disruption. All injuries of popliteal arteries and veins
repaired with saphenous vein interposition. On follow up, we observed that the saphenous vein grafts were thrombosed. We suppose that
vascular injuries occurred in those cases due to both penetrating and blunt mechanisms. Repeated thrombectomy was performed, and the
patency of the grafts were achieved. Heparin infusion (1000U/hour) was administered in first postoperative 24 hours, and the patient
was followed up every hour to keep activated clotting time ≥200 sec. Consequently, saphenous veins of both cases were protected from
thrombosis. In conclusion, combination of penetrating and blunt trauma causing fractures and vascular injury to lower extremities can be
managed with coordination of orthopedic, vascular and plastic surgeons. Prompt diagnosis, early intervention, heparin infusion in first 24
hours and continuing with low-molecular-weight heparin results in successful management with palpable distal pulses and limb salvage in
those challenging injuries.

Key words: Popliteal artery; popliteal vein; vascular system injuries.






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