| Popis: |
In Turkey, farm machinery accidents are important factors for morbidity and mortality. In Western Black sea region, a specific farming toolis 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 defectwith popliteal nerve and artery disruption as determined by digital subtraction angiography. The second case had a right Gustilo-Andersontype IV open proximal tibial fracture, distal femoral fracture, and popliteal artery disruption. All injuries of popliteal arteries and veinsrepaired with saphenous vein interposition. On follow up, we observed that the saphenous vein grafts were thrombosed. We suppose thatvascular injuries occurred in those cases due to both penetrating and blunt mechanisms. Repeated thrombectomy was performed, and thepatency of the grafts were achieved. Heparin infusion (1000U/hour) was administered in first postoperative 24 hours, and the patientwas followed up every hour to keep activated clotting time ?200 sec. Consequently, saphenous veins of both cases were protected fromthrombosis. In conclusion, combination of penetrating and blunt trauma causing fractures and vascular injury to lower extremities can bemanaged with coordination of orthopedic, vascular and plastic surgeons. Prompt diagnosis, early intervention, heparin infusion in first 24hours and continuing with low-molecular-weight heparin results in successful management with palpable distal pulses and limb salvage inthose challenging injuries |
