The Back Single Incision In The Treatment Of Osteofacial Compartment Syndrome After Popliteal Artery Injury

Objiective:To explore the feasibility of back single-incision four-compartment fasciotomy in the treatment of acute leg compartment syndromes with popliteal artery injury.Methods:Based on the reasearch of the knee and leg anatomy,we design the back single-incision four-compartment fasciotomy in the treatment of acute leg compartment syndromes with popliteal artery injury.Since july 2015 to november2016,there are 5 patients with popliteal artery injury while 4 cases are male and 1case is female.4 cases with left side while 1 case of right side,aged from 35 ~ 55 years old,the averaged age of fourty-three,one patiention with merge tibial plateau fracture,three case with tibiofibula fracture,one case with soft tissue injury,5 ~9hours admitted to hospital after injury,average of 7 hours.The lateral crus are swelling and skin tension increased when then are admitted.There are one case combined tension blisters,skin temperature is low,and can’t touch,the pulse of dorsalis pedis artery is negative.The activity of knee and ankle jioint is somewhat limited.The time of operation is 1~3h after admission.Patients after general anestheia in prone position,and protect the area frome pressure sores.Tigh bound water flooding blood pressure(45mm Hg)last for 1h and continuous 15 ~ 30 min.The incision slect accordiing to the open injury or popliteal frossa centered a shape of S line for closed injury.We should pay attendion toprotect saphenous vein and sural nerve.Be careful to detect blood vessels,nerve damage.After fixation or joint fracture reduction and fixation,debridement,then repair popliteal artery and popliteal nein by micoscope.When it is necessary to take the side of the great saphenous vein for repair.Separating back and subcutaneous,medial and lateral from muscle membrane.An incision is made from crus,to seprate top interosseousmembrane.We should outward stretch subcutaneous in order to identify the tibialis anterior and anterolateral,when seperate stealth anterolateral,deep fascia and muscle of the side membrane protecting by hand.Distal dorsalis artery,posterior tibial vein pulsing can hit,muscle is ruddy and can stimulate after that.In order to raise the limb to improve limb yenous and lymphatic retum fixed the knee flexion 30°.Sodium aescinate is used to sodium deydration detumescence,and low molecular weight heparin is used to prevent blood clots while antibiotics used for 5 ~ 7days,papaverine used for 3 days,alprostadil used for 5 ~ 7 days.We guid the calf muscles inpatients with toes and ankles do isometric contraction and activity after operation for 2 days.Results:We choose free skin graft or closure directly according to the swelling and wound infection situation after operation for 1 week.Skin graft and the wound healed well,there is no infection,skin and muscle tissue necrosis afteroperation.Popliteal artery blood flow and dorsalis pedis artery can be hit.The calf muscle stength,and the joint activities are somewhat limited.Ankle and toes activity is normal.The group of 5patients were flowed up,and the time is 7 ~ 20 months while average follow-up time is 14 months.The feeling of the crus is nomall.The skin feeling of sealed edge is slightly numb while ankle and toes activity is nomal,the knee joint activities.Four patients recovery,return to the original work after fractur healing except1 case with knee joint back surgery scar hyperplasia of mild and slightly affect patients with knee joint extending activities.Conclusion:The back single incision can complete decompress the press of four-compartment fasciotomy.When relative to the lateral incision,the back light can effectively protect phil total nerve,pjil shallow nerve,and edge skin lessions,and sufficient decompress the press of back deep room.It’s no blood circulation obstacle of skin and no damage of skin conditions when repair the other injure.