Lower extremity vascular injuries

Question 1

What is the incision that allows the fastest access to the external iliac artery?

Answer 1

retro-peritoneal approach through an incision above the inguinal ligament
-curvilinear incision from point 1-2 fingerbreadths above the ASIS -extending to a point just above the ligament
-carry down to EO fascia which is incised and the transversus muscle and transversalis fascia are opened laterally
-retract peritoneum medially

Question 2

What is the course of the femoral artery?

Answer 2

from inguinal ligament through adductor canal (Hunter’s canal) to popliteal fossa

Question 3

Where should the incision be placed to expose the common femoral artery?

Answer 3

2 fingerbreadths lateral to pubic tubercle from a point 1-2cm above the pubic tubercle and extended caudally along the medial border of the sartorius muscle

Question 4

What vein lies in close proximity to the profunda femoris artery and should be identified and protected or ligated to avoid profuse bleeding?

Answer 4

lateral femoral circumflex

Question 5

What area should be prepped when operating for a vascular injury below the femoral bifurcation?

Answer 5

both groins, abdomen to xyphoid, BLE to include feet

Question 6

Where should an incision be placed to access the SFA?

Answer 6

inferior border of the sartorius muscle

Question 7

Where does the blood supply for the sartorius muscle enter the muscle?

Answer 7

inferior edge, so be careful when trying to expose the SFA
-medial aspect of the lower thigh in the palpable groove between the vastus medialis and sartorius muscles

Question 8

Which two muscle border Hunter’s canal?

Answer 8

vastus muscle is lateral to the popliteal canal
adductor muscle is medial to Hunter’s

Question 9

Which nerve should be identified and preserved when exposing the SFA?

Answer 9

saphenous nerve

Question 10

How many genicular branches of the popliteal artery are there?

Answer 10

5

Question 11

Which two muscles sandwich the below the knee popliteal?

Answer 11

gastrocnemius and popliteus

Question 12

What structure covers the popliteal fossa and vessels from a medial perspective?

Answer 12

semitendinosus (and its confluence w/ the gracilis and sartorius muscle to form the pes anserinus) and the semimembranosis

Question 13

What is the relationship of the popliteal artery to the popliteal vein?

Answer 13

the artery is medial to the vein

Question 14

Where should an incision be placed to expose the infra-geniculate popliteal artery?

Answer 14

1-2cm distal to the medial femoral condyle and 1cm behind the tibia
-it needs to be about 10cm

Question 15

Where is the tibial nerve located in relation to the below knee popliteal vessels?

Answer 15

posterior-medial
-avoid this

Question 16

Compression of which nerve is an early sign of LE compartment syndrome and what deficit is noted?

Answer 16

-superficial peroneal (fibular) nerve
-sensation loss in web space between first two toes

Question 17

Where should the lateral incision for a lower leg fasciotomy be placed?

Answer 17

1-2cm anterior to the edge of the fibula from 2-3 fingerbreadths below the tibial plateau to 2-3 fingerbreadths above the lateral malleolus
-1 Fingerbreadth inFront of the Fibula

Question 18

Which two subcutaneous structures need to be avoided in the lateral incision of a lower leg fasciotomy?

Answer 18

lesser saphenous vein
peroneal/fibular nerve

Question 19

What structures can help you identify the intramuscular septum in the lateral incision of a lower leg fasciotomy?

Answer 19

perforating vessels that emerge from here

Question 20

Which compartment is the most commonly missed during a lower leg fasciotomy?

Answer 20

anterior compartment
-d/t incision being too far posterior

Question 21

Where should the medial incision for a lower leg fasciotomy be placed?

Answer 21

1-2cm posterior to the edge of the medial edge of the tibia from 2-3 fingerbreadths below the tibial plateau to 2-3 fingerbreadths above the medial malleolus
-1 Thumb behind the Tibia

Question 22

What vein needs to be identified and avoided in the medial incision of a lower leg fasciotomy?

Answer 22

saphenous

Question 23

What can be used to identify that the deep posterior compartment has been entered?

Answer 23

seeing the neurovascular bundle

Question 24

How many compartments are in the thigh?

Answer 24

3: anterior, posterior, medial

Question 25

Which thigh compartment contains the femoral artery?

Answer 25

anterior

Question 26

Which thigh compartment is the most likely to develop compartment syndrome?

Answer 26

anterior

Question 27

For a thigh fasciotomy which incision should be made first as it will likely the only one needed?

Answer 27

lateral

Question 28

What are the 3 gluteal compartments?

Answer 28

-tensor compartment
-medius-minimus compartment
-maximus compartment

Question 29

What is the eponym for a gluteal fasciotomy incision?

Answer 29

Kocher-Langenback

Question 30

What is the positioning for a pt undergoing a gluteal fasciotomy?

Answer 30

lateral decubitus with the hip flexed 90deg