Surgical treatment of the lower leg open fracture with lesions of the main blood vessels: A case report

Stojiljković, Predrag; Jovanović, Milan; Golubović, Ivan; Radovanović, Zoran; Stevanović, Goran; Golubović, Ivana; Đorđević, Dušan; Mitić, Aleksandar; Milijić, Svetlana; Golubović, Zoran

doi:10.2298/VSP160613343S

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Vojnosanitetski pregled

2018, vol. 75, br. 4, str. 422-427

Hirurško lečenje otvorenog preloma potkolenice sa lezijom magistralnih krvnih sudova

Stojiljković Predrag^a, Jovanović Milan^a, Golubović Ivan^a, Radovanović Zoran^b, Stevanović Goran^c

, Golubović Ivana^b, Đorđević Dušan^d, Mitić Aleksandar^b, Milijić Svetlana^b, Golubović Zoran^a

^aKlinički centar Niš, Klinika za ortopediju
^bUniverzitet u Nišu, Medicinski fakultet
^cKlinički centar Niš, Klinika za plastičnu hirurgiju
^dMilitary Medical Hospital, Niš

e-adresa: doktorzorangolubovic@gmail.com

Projekat:

Virtuelni koštano zglobni sistem čoveka i njegova primena u pretkliničkoj i kliničkoj praksi (MPNTR - 41017)

Ključne reči: potkolenica; prelomi; povrede; otvorene; dijagnostičke tehnike i procedure; hirurgija; operativne procedure; graftovi; režnjevi; hirurški; funkcija; povratak

Sažetak

Otvoreni prelomi potkolenice III C stepena po Gustilu spadaju u najteže otvorene prelome potkolenog segmenta. Često su praćeni, pored povreda krvnih sudova, i velikim oštećenjem mekotkivnog omotača potkolenice. Prikaz bolesnika. Bolesnik, star 20 godina, zadobio je težak otvoreni prelom leve potkolenice u saobraćajnoj nesreći, sa prekidom kontinuiteta magistralnih arterija leve potkolenice. Nakon kliničkog pregleda i radiološke dijagnostike, urađena je primarna obrada rane otvorenog preloma, repozicija fragmenata leve potkolenice i stabilizacija otvorenog preloma spoljnim skeletnim fiksatorom. U postoperativnom toku došlo je do manifestacije akutne ishemije levog stopala. Arteriografski je bio verifikovan diskontinuitet sve tri kruralne arterije u nivou linije preloma. Bolesnik je hitno operisan. Revaskularizacija ekstremiteta izvedena je rekonstrukcijom prednje tibijalne arterije interpozicionim safenskim graftom, dužine 15 cm, uz kreiranje distalne anastomoze u nivou dorzalne arterije stopala. Veliki mekotkivni defekt i rekonstruisani krvni sudovi prekriveni su fasciokutanim transpozicionim režnjem. Postoperativni tok praćen je urednom prohodnošću grafta. Na kontrolnom rentgenskom snimku verifikovan je lom distalnog klina spoljnog skeletnog fiksatora, uz zarastanje preloma tibije sa angularnim deformitetom. Spoljni skeletni fiksator je odstranjen, osim zaostalog dela klina u distalnom delu potkolenice. Na kontrolnom pregledu po završenom lečenju, bolesnik je hodao bez pomagala. Zaključak. Spoljna skeletna fiksacija preloma, rekonstrukcija povređenih krvnih sudova i rano pokrivanje mekotkivnog defekta potkolenice su osnovni elementi u spašavanju povređenog ekstremiteta. Dugoročni cilj lečenja je potpuni funkcionalni oporavak povređenog ekstremiteta i pun povratak bolesnika životnim i radnim aktivnostima.

Abstract

Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.

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O članku

jezik rada: engleski
vrsta rada: prikaz slučaja
DOI: 10.2298/VSP160613343S
objavljen u SCIndeksu: 09.08.2018.
metod recenzije: dvostruko anoniman

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