Popliteal Artery Injury Associated with Blunt Trauma to the Knee without Fracture or Dislocation
Having the first intervention done at another health center, a 38-year-old male patient engaged in mining, presented to our emergency department (ED) with an isolated crush injury of the left leg 18 hours after lateral and medial sides of his left knee was temporarily squeezed at a high speed between a tree and an operative machine. The patient’s history revealed that he presented to the hospital 5 hours after the injury as the skin did not have a laceration. Investigation of the epicrisis reports and hospital records revealed that the patient underwent Doppler ultrasonography at the sixth hour. The Doppler examination revealed the presence of a probable thrombus\in the popliteal area. An embolectomy was attempted with a Fogarty catheter, but was unsuccessful as the catheter did not pass through the distal area. The patient presented to our ED at the 18th hour of the injury. In the immediate physical examination of the patient, the left knee level showed signs of paleness, coldness, anesthesia, hemorrhagic bullae, and ecchymosis posterior to the knee (). Tibialis posterior, dorsalis pedis, and popliteal arterial pulses were not felt. There was no motor function of the ankle and the toes. Successive tendon examination did not show any signs indicating a possible tendon injury. Radiographs of the leg did not show any bone pathology. The previously performed angiography revealed that the popliteal artery was totally occluded and there was no pathway to distal flow (). The patient was transfused 2 units of blood for hematocrit <27%, and as his general condition deteriorated an above-knee amputation was undertaken.\nUnder spinal anesthesia, the patient was placed in the supine position in a sterile field. Knee tendon examinations did not reveal any pathological finding under anesthesia.\nA fish-mouth incision was performed over the skin and the fascia. The bone was shortened 10 cm proximal to the femoral condyle. The popliteal artery and the vein were identified, tied, and cut. The proximal sciatic nerve was dissected, tied, and cut. The adductor magnus muscle was attached to the distal femur rudiment with ticron sutures. The amputation stump was sutured (). Following surgery, when the amputation was investigated, 3 cm of intimal damage to the popliteal artery was detected and necrosis of the muscle, tendon, and neurovascular structures was present at this level. During the post-operational period, no complications developed in the wound and the patient was followed-up on for 2 years.