Knee dislocation is an orthopedic injury that can lead to popliteal artery injury and subsequent acute limb ischemia. The medial approach to the popliteal vessels does not allow exposure to the total length of the popliteal artery. On the contrary, the posterior approach can reveal clearly the lesion area. 

Ok, what am I talking about? A few words:

The patient face-down.

An S-shape incision on the posterior knee (the horizontal of the S-shape on the knee crease)

Almost always, you get into a mess. Blood everywhere, injured tissues, skin degloving. You have nothing more to do; carry on. Find the tibial nerve, put it aside, find the popliteal vein and carefully dissect it away from your target: the adjacent popliteal artery. Put slings proximally and distal and get ready to rock.

Ask from the anesthetist to heparinize the patient. Clamps (always proximally, where I prefer a baby-Scatinsky clamp, occasionally distally).

Grab a knife and make a longitudinal incision.  Remove the thrombus from the lumen of the injured artery and have a careful view. In most of the cases, if the artery is not already fully transected, the endothelium is ruptured.

Clear the interior of the artery and make a proper embolectomy distally, and then proximally.

Ok, everything is ready for artery closure. In most cases, I prefer either an end-to-end anastomosis of the portions of the artery proximally and distally to the injured endothelium or, more often, a very short interposition graft (1-2 cm long) usually a great saphenous vein graft. Almost always, Polypropylene 6/0, on a parachute fashion.

Extra tips? Magnification (2.5x at least) and good lighting (prefer head lighting).

 

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