Hirurško lečenje otvorenog preloma potkolenice sa lezijom magistralnih krvnih sudova
Sažetak
Apstrakt
Uvod. Otvoreni prelomi potkolenice III C stepena po Gustilu spadaju u najteže otvorene prelome potkolenog segmenta. Često su praćeni, pored povreda krvnih sudova, i velikim oštećenjem mekotkivnog omotača potkolenice. Prikaz bolesnika. Bolesnik, star 20 godina, zadobio je težak otvoreni prelom leve potkolenice u saobraćajnoj nesreći, sa prekidom kontinuiteta magistralnih arterija leve potkolenice. Nakon kliničkog pregleda i radiološke dijagnostike, urađena je primarna obrada rane otvorenog preloma, repozicija fragmenata leve potkolenice i stabilizacija otvorenog preloma spoljnim skeletnim fiksatorom. U postoperativnom toku došlo je do manifestacije akutne ishemije levog stopala. Arteriografski je bio verifikovan diskontinuitet sve tri kruralne arterije u nivou linije preloma. Bolesnik je hitno operisan. Revaskularizacija ekstremiteta izvedena je rekonstrukcijom prednje tibijalne arterije interpozicionim safenskim graftom, dužine 15 cm, uz kreiranje distalne anastomoze u nivou dorzalne arterije stopala. Veliki mekotkivni defekt i rekonstruisani krvni sudovi prekriveni su fasciokutanim transpozicionim režnjem. Postoperativni tok praćen je urednom prohodnošću grafta. Na kontrolnom rentgenskom snimku verifikovan je lom distalnog klina spoljnog skeletnog fiksatora, uz zarastanje preloma tibije sa angularnim deformitetom. Spoljni skeletni fiksator je odstranjen, osim zaostalog dela klina u distalnom delu potkolenice. Na kontrolnom pregledu po završenom lečenju, bolesnik je hodao bez pomagala. Zaključak. Spoljna skeletna fiksacija preloma, rekonstrukcija povređenih krvnih sudova i rano pokrivanje mekotkivnog defekta potkolenice su osnovni elementi u spašavanju povređenog ekstremiteta. Dugoročni cilj lečenja je potpuni funkcionalni oporavak povređenog ekstremiteta i pun povratak bolesnika životnim i radnim aktivnostima.
Reference
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