Ulus Travma Acil Cerrahi Derg. 2006; 12(3): 242-244

Ateþli silah yaralanmasýna baðlý greft enfeksiyonlarýnda alternatif yöntem “retro-sartorius baypas”: Olgu sunumu

Cengiz Bolcal, Hakan Bingöl, Ahmet Turan Yýlmaz, Harun Tatar
Gülhane Askeri Týp Akademisi, Kalp Ve Damar Cerrahisi Anabilim Dalý, Ankara

Sentetik greft kullanýlan periferik damar ameliyatlarýndan sonra greft enfeksiyonlarý görülebilir. Ateþli silahlý yaralanmasýndan sonra sentetik greftle femoro-femoral baypas yapýlan ve geniþ doku defekti bulunan bir hasta kliniðimize kabul edildi. Distal pedal nabýzlar palpe edilebiliyordu. Beþinci günde hastada greft bölgesinde kanama oldu ve hasta acil olarak ameliyata alýndý. Ýlk olarak enfekte greft materyeli çýkarýldý. Daha sonra lomber insizyonla eksternal iliyak artere PTFE greftin proksimal anastomozu yapýldý. Krista iliyaka süperiyorun mediyalinden ve inguinal ligamentin altýndan bir tünel oluþturuldu. Enfekte alaný dýþarýda býrakacak þekilde sartorius kasýnýn arkasýndan, PTFE greft bu tünelden geçirildi ve süperfisiyal femoral artere anastomoz edildi. Kontrol anjiyografisinde anostomozlarýn açýk olduðu gözlendi. Geniþ doku kayýplarýnýn bulunduðu greft enfeksiyonlarýnda alternatif bir giriþim olarak retro-sartorius baypas baþarýyla uygulanabilir bir seçenektir.

Anahtar Kelimeler: Femoral ven/cerrahi, greft enfeksiyonu; periferik damar rahatsýzlýðý/cerrahi; protez iliþkili enfeksiyon/cerrahi.

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“Retro-sartorius bypass” an alternative method during graft infection due to gunshot wound: a case report

Cengiz Bolcal, Hakan Bingöl, Ahmet Turan Yýlmaz, Harun Tatar
Department Of Cardiovascular Surgery, Gülhane Military Academy Of Medicine, Ankara, Turkey

Graft infections can be seen after the peripheric vascular operations using synthetic graft. The patient who had femoro-femoral bypass with synthetic graft after a gunshot wound admitted to our department with graft infection and wide tissue loss. The distal pedal pulses were palpable. At the fifth day, the patient had a bleeding on the graft site and underwent emergency operation. Firstly the infected graft material was excised. Then the proximal end of the PTFE graft anastomosed to the external iliac artery with the lomber incision. A tunnel was formed just medial to the superior crista iliaca and under the inguinal ligament. The PTFE graft was passed through this tunnel excluding the infected area behind sartorius muscle and anastomosed to superficial femoral artery. Control angiography revealed that anastomoses were patent. At the graft infections which are especially with wide tissue loss, the retro-sartorious bypass surgery can be performed successfully as an alternative procedure.

Keywords: Femoral vein/surgery, graft infection; peripheral vascular diseases/surgery; prosthesis-related infections/surgery.

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