1/11. Pseudoaneurysm of the superficial femoral artery following accidental trauma: result of treatment by percutaneous stent-graft placement.Accidental trauma frequently involves the extremities, and can extend to involve their blood supply, causing exsanguinating hemorrhage and pseudoaneurysm in the involved blood vessel. This is traditionally managed by surgical repair. We report a case in which control of life-threatening hemorrhage and exclusion of a large, post-traumatic pseudoaneurysm in the superficial femoral artery was performed by a commercially available stent-graft, without complication. This treatment method may be a safe and effective alternative to surgery in selected patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Plating of femoral shaft fractures. A review of 15 cases.The objective of this study was to define the role, indications and outcome of plating in femur shaft fractures. All femoral shaft fractures admitted and treated by the authors during a 2-year period were analysed. The authors personally treated a total of 135 femur fractures. Of these 135 fractures, 15 (11%) were treated with primary plating. The femoral fractures were classified as grade I (n = 4), grade III (n = 3), grade IV (n = 4), grade V (n = 3), and grade VII (n = 1) (OTA classification). Three patients sustained open fractures (one grade I and two grade II, Gustilo and Anderson classification). Pelvic (6) or ipsilateral lower extremity injuries (4) occurred in 10 of the 15 patients. A total of 23 body areas were injured, most commonly the chest (n = 10), abdomen (n = 5), head (n = 6) and blood vessels (n = 3). There were no infections reported. Two implant failures were noted. femur plating is a useful technique in polytrauma patients for specific indications where intramedullary nailing (IMN) may be contra-indicated or technically not feasible. Although the postoperative morbidity (ARDS, death) in our study seems to be lower after plating than after intramedullary nailing, the rate of complications of fracture healing (30%) is significantly greater with femur plating than with intramedullary nailing (12%).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Ipsilateral free fibula transfer for reconstruction of a segmental femoral-shaft defect.We describe an ipsilateral free fibula transfer for segmental femur reconstruction with venous interpositional grafts. Preparation and use of vessels at the recipient site for microvascular anastomosis is avoided. This represents a valuable modification of previously reported techniques, and should be considered as an alternative to conventional techniques, which regularly require more dissection at the reconstructive site.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/11. Supracondylar femur nonunion associated with previous vascular repair: importance of vascular exam in preoperative planning of nonunion repair.One case of a Gustilo type 3C open OTA 33A-1 supracondylar femur fracture with superficial femoral artery injury that underwent reverse saphenous vein graft repair and open reduction and internal fixation with a retrograde femoral nail is reviewed. The fracture progressed to a hypertrophic nonunion despite 2 bone-grafting procedures and a nail dynamization. Upon referral for revision of the nonunion, a vascular examination revealed a well-perfused extremity with slightly diminished pedal pulses. An arteriogram was ordered that revealed an intraosseous aneurysm associated with the nonunion site and vascular repair. In a joint procedure with vascular and orthopedic surgeons, the previous vessel repair was mobilized, the aneurysmal feeder vessels were ligated, and the nonunion was revised with bridge plating and iliac crest autograft. The nonunion healed uneventfully, and the patient shows no signs of vascular compromise at the 2-year follow-up. The importance of the preoperative vascular assessment is emphasized, and the literature is reviewed.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/11. Intramedullary reaming and nailing: its early effects on cortical bone vascularization.The early effect of reaming the medullary cavity prior to intramedullary nailing using Kuntscher's method, on human cortical bone vascularization in the femur is discussed. In sections of the femur where the medullary tissue had been totally reamed, the inner two-thirds of the cortical bone tube was completely avascularized one week after the reaming. In the outer third of the cortex the vascularization was only moderately decreased. In the parts of the femur where the medullary tissue was not totally destroyed there was a marginal effect on the amount of intact cortical vessels. The observation is thus in accordance with corresponding results from experimental studies on animals. Microcracks, and cracks in the cortical wall, caused by the reaming and procedure are also described in the article.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/11. False aneurysm of the profunda femoris artery complicating fracture of the femoral shaft and treated by transcatheter embolization. A case report.False aneurysm of the profunda femoris artery is a serious complication following fractures of the femoral shaft. Development of the false aneurysm is due to either initial injury of the vessel or is a complication of internal fixation of the femoral fracture. Clinical diagnosis is confirmed by selective arterial angiography after occurrence of a significant haemorrhage or pulsatile swelling in the injured thigh. Our case confirms the effective use of selective arterial angiography in the diagnosis of a false aneurysm of the profunda femoris. Simultaneously therapeutic embolization of the localized false aneurysm was undertaken successfully. diagnosis and management of the false aneurysm of the profunda femoris artery (distal third) was carried out within 30 minutes.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/11. Free vascularized bone transplants in problematic nonunions of fractures.Three cases with nonunion of long bones and problems of bone loss or infection, when conventional bone graft would probably not have been successful, were treated successfully by free vascularized bone transplant to provide a vascular bed in the nonunion site and internal splint, the donor bone being the composite rib graft based on posterior intercostal vessels and proximal fibula based on its peroneal vascular pedicle. The operative technique was divided into five stages, and each stage posed different problems at the donor and recipient areas and vessel anastomoses. Despite these disadvantages, all three cases proceeded to solid bony union in less than 4 months after surgery. Thus the patients were able to be rehabilitated early to retain satisfactory limb function within a relatively short period of time.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/11. Vascular injuries associated with penetrating wounds of the groin.Thirty-two patients were operated upon for suspected vascular injury following penetrating wounds of the groin. This injury is not uncommon, the patients survive to reach the hospital, and they require aggressive management. Vascular damage was found in 23 of the patients; there were no deaths and only one amputation. Eighteen of the 23 who had vessel injury were in shock upon arrival at the hospital. Of those subsequently found to have no vessel damage, none was in shock. Pulses distal to the injury were noted in six of the 23 patients. Arteriograms performed and interpreted by the surgery residents were helpful but not completely reliable. The repaired vessel must be covered adequately with viable tissue. The one amputation was in a patient in whom there was insufficient tissue to cover the repaired vessel. We conclude that general surgeons should be capable of managing this vascular injury.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
9/11. Gastrocnemius muscle transposition to the femur: how high can you go?The gastrocnemius muscle flap has gained wide acceptance as a reconstructive technique for management of wounds of the knee and proximal tibia. The use of the muscle as a pedicle flap to the distal and middle femur has not been well quantified, and the proximal rotation arc has been underestimated. We report the use of the island gastrocnemius pedicle flap to reach two femur defects 21 and 26 cm above the joint line, achieved by taking advantage of the favorable location of the vascular pedicle above the joint line and the individual length of the medial gastrocnemius muscle belly. Evaluation of standard arteriograms suggests the location of the medial sural artery pedicle is an average of 32 /- 14.5 (SD) mm above the inferior border of the femur. All vessel origins were found above the joint line by radiograph. A common sural artery origin was noted in 32% of patients at a mean distance of 35 mm proximal to the joint line. Despite a wide range, 62% of sural artery origins were within 1 cm of an axis drawn through the widest point of the femoral condyles.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/11. Fracture callus in osteopetrosis.The histologic features of bone callus after a traumatic fracture in a patient with osteopetrosis are presented. The fracture callus develops in stages that are apparently normal. The tissue is initially rich in bone-forming cells and vessels. One year later, however, unlike mature osteopetrotic bone, the tissue shows no Haversian organization.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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