Lower extremity vascular injuries Flashcards
What is the incision that allows the fastest access to the external iliac artery?
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
What is the course of the femoral artery?
from inguinal ligament through adductor canal (Hunter’s canal) to popliteal fossa
Where should the incision be placed to expose the common femoral artery?
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
What vein lies in close proximity to the profunda femoris artery and should be identified and protected or ligated to avoid profuse bleeding?
lateral femoral circumflex
What area should be prepped when operating for a vascular injury below the femoral bifurcation?
both groins, abdomen to xyphoid, BLE to include feet
Where should an incision be placed to access the SFA?
inferior border of the sartorius muscle
Where does the blood supply for the sartorius muscle enter the muscle?
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
Which two muscle border Hunter’s canal?
vastus muscle is lateral to the popliteal canal
adductor muscle is medial to Hunter’s
Which nerve should be identified and preserved when exposing the SFA?
saphenous nerve
How many genicular branches of the popliteal artery are there?
5
Which two muscles sandwich the below the knee popliteal?
gastrocnemius and popliteus
What structure covers the popliteal fossa and vessels from a medial perspective?
semitendinosus (and its confluence w/ the gracilis and sartorius muscle to form the pes anserinus) and the semimembranosis
What is the relationship of the popliteal artery to the popliteal vein?
the artery is medial to the vein
Where should an incision be placed to expose the infra-geniculate popliteal artery?
1-2cm distal to the medial femoral condyle and 1cm behind the tibia
-it needs to be about 10cm
Where is the tibial nerve located in relation to the below knee popliteal vessels?
posterior-medial
-avoid this
Compression of which nerve is an early sign of LE compartment syndrome and what deficit is noted?
-superficial peroneal (fibular) nerve
-sensation loss in web space between first two toes
Where should the lateral incision for a lower leg fasciotomy be placed?
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
Which two subcutaneous structures need to be avoided in the lateral incision of a lower leg fasciotomy?
lesser saphenous vein
peroneal/fibular nerve
What structures can help you identify the intramuscular septum in the lateral incision of a lower leg fasciotomy?
perforating vessels that emerge from here
Which compartment is the most commonly missed during a lower leg fasciotomy?
anterior compartment
-d/t incision being too far posterior
Where should the medial incision for a lower leg fasciotomy be placed?
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
What vein needs to be identified and avoided in the medial incision of a lower leg fasciotomy?
saphenous
What can be used to identify that the deep posterior compartment has been entered?
seeing the neurovascular bundle
How many compartments are in the thigh?
3: anterior, posterior, medial
Which thigh compartment contains the femoral artery?
anterior
Which thigh compartment is the most likely to develop compartment syndrome?
anterior
For a thigh fasciotomy which incision should be made first as it will likely the only one needed?
lateral
What are the 3 gluteal compartments?
-tensor compartment
-medius-minimus compartment
-maximus compartment
What is the eponym for a gluteal fasciotomy incision?
Kocher-Langenback
What is the positioning for a pt undergoing a gluteal fasciotomy?
lateral decubitus with the hip flexed 90deg
