Salvage of Long Segment Artery Defect of Lower Limb by Long Segment Vein Graft Associated with a Polytetrafluoroethylene Graft Conduit Protection -- A Case Report

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Abstract

Background: Severe injury to the extremities is a life-threatening event which may lead to a myriad of disabilities. Before considering amputation, physicians should always evaluate if revascularization and replantation are achievable after thoroughly assessing the status of the patient's injury and hemodynamic condition. However, the therapeutic plan is often complicated by the presence of several factors, such as an advanced age, a degloving wound, involvement of a neurovascular injury or comminuted fracture, prolonged ischemia time, and concomitant diseases. Materials and Methods: Herein, we present a geriatric patient who suffered from a high-energy traumatic injury. A massive degloving wound with severe detachment of skin, subcutaneous fat, and muscle were seen over the patient's left lower limb. Her circulation was disrupted at the popliteal level, and segmental loss of popliteal artery was seen during emergent surgery. We restored the arterial perfusion of patient's traumatized limb with an autologous vein graft, but there was not enough soft tissue to cover the vein graft. A polytetrafluoroethylene (PTFE) graft was deployed outside of great saphenous vein graft for temporally conduit protection. Results: The patient underwent a series of reconstructive surgeries within 2 months after the incident. The swelling of her left lower limb subsided gradually, and the PTFE graft was removed on post injury day 21 as the vein graft was able to be covered by muscle flap and skin graft. Computed tomography angiography showed good patency of the vein graft on the 9^(th) month after the accident. The functional outcome of the patient's limb was greatly preserved in one-year follow-up. Conclusion: In our case, the vascular reconstruction was successfully achieved, and the function of the traumatized limb was also well preserved. This case report shows that the polytetrafluoroethylene graft can play a big role in temporarily protecting the vein graft when there is insufficient soft tissue coverage.
Original languageEnglish
Pages (from-to)126-133
Number of pages8
Journal中華民國整形外科醫學會雜誌
Volume29
Issue number2
Publication statusPublished - 2020

Keywords

  • popliteal artery injury
  • vascular reconstruction
  • emergency vascular injuries
  • polytetrafluoroethylene (PTFE) graft

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