Editor-in-Chief Ufuk Demirkılıç Frequency Quarterly Abbreviation Turk J Vasc Surg Publisher Turkish National Vascular and Endovascular Surgery Society ISSN 2667-4947 E-ISSN 2667-5080


Turkish Journal of Vascular Surgery 2019 , Vol 28 , Issue 1
Multidisciplinary approach in "pat pat" injuries: the role of vascular surgeon
Okay Güven Karaca1, İlhan Mavioğlu1, Mustafa Haluk Akbaş1, Ayşegül Koç1, Zekeriya Okan Karaduman2, Ayşegül Kunt3
1Department of Cardiovascular Surgery, Faculty of Medicine Düzce University, Düzce, Turkey
2Department of Orthopedics and Traumatology, Faculty of Medicine Düzce University, Düzce, Turkey
3Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
DOI : 10.9739/uvcd.2016-53628 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. Keywords : Popliteal artery; popliteal vein; vascular system injuries