Ordinary injury, big surprise - Traumatic false aneurysm and arteriovenous fistula of the posterior tibial artery after civilian trauma: A case report

Introduction

False traumatic aneurysm (FTA) or pseudoaneurysm and traumatic arteriovenous fistulas (TAVF) are rare pathologies in civilian trauma and mainly result from stabs or gunshot wounds. The posterior tibial artery as site of trauma is very rare.

Presentation of case

We report on a 39-year old female patient who was suffering from combined FTA and TAVF of the posterior tibial artery after falling into a wine glass. CT-imaging as well as duplex ultrasound and selective arteriography were performed, and two stent-grafts were inserted.

Discussion

Based on the presented case, incidence of the described pathology, treatment options and outcomes are discussed.

Conclusion

Adequate imaging in penetrating wounds to the extremities is crucial in order to provide diagnosis and treatment of concomitant lesions.

Anterior Rectus Sheath Autograft in WRAP-Augmentation of Achilles Tendon Rupture

Achilles tendon ruptures can be counted as the most common traumatic ankle injuries. As such, there is a comparatively large set of treatment options including surgical and nonsurgical approaches. The purpose of this case report is to demonstrate a new technique for a specific subgroup of Achilles tendon ruptures that present with a large tendinous gap. We used a 2-step procedure designed to grant additional stability through an autograft from the anterior rectus sheath of the patient. Two patients were treated after suffering traumatic Achilles tendon ruptures on the left side with a gap of >3.5 cm and a high demand in daily activities. The reconstruction was performed using an upper quadrant recuts sheath as a WRAP-augmentation. After securing the transplant tissue, the abdominal wall was reconstructed using a Vicryl™-Prolene™ mesh (VYPRO^®, Johnson & Johnson Medical GmbH, Ethicon Deutschland, Norderstedt, Germany). After, a standard approach to the Achilles tendon was performed with a Kirchmayr-Kessler suture. The end result was then stabilized with a rectus sheath WRAP over a length of 14 to 15 cm. On the cases reported here, multiple clinical follow-ups were performed over a 5-year period. We can report highly satisfying results, with a return to sports activity after 6 months and no complications. As such we believe the rectus sheath autograft an effective solution for Achilles tendon ruptures with large gaps in healthy patients that demonstrate a high demand in daily activities.

Illustrated operative management of spontaneous bleeding and compartment syndrome of the lower extremity in a patient with acquired hemophilia A: a case report

INTRODUCTION

Spontaneous bleeding resulting in compartment syndrome at the lower adult leg due to acquired hemophilia A is rare. There are no reports on operative management of this entity.

CASE PRESENTATION

We present a case of atraumatic compartment syndrome of the lower leg due to acquired factor VIII deficiency, in an 83-year-old Caucasian man of European descent. He was treated surgically with a long and complicated postoperative course after presenting to a community hospital with a 2-day history of increasing pain and swelling in his left lower leg without a previous history of trauma.

CONCLUSIONS

Awareness, prompt diagnosis and effective treatment of compartment syndrome caused by a rare bleeding disorder, which is usually acquired by the elderly, is essential and may spare a patient from surgery or even limb loss, if early administration of recombinant factor VIIa is effective. The course of disease in a patient with operative management of spontaneous bleeding, compartment syndrome and acquired hemophilia A may be prolonged. However, an interdisciplinary approach with meticulous surgical treatment and bleeding management with recombinant factor VIIa as well as inhibitor eradication by immunosuppressive treatment can be successful and expensive.

Animal experiments for the determination of an optimal wavelength for retinal coagulations

The retina of rabbits was coagulated with different wave-lengths (570-630 nm) using a tunable dye laser with Rhodamin 6G. To achieve comparable ophthalmoscopic appearance the intensity of the laser beam was varied with neutral filters of varying absorption. Histologic examination of fresh coagulation effects and 3-week-old coagulation scars showed no difference in relation to the wave-length used. Theoretically, 577 nm seems to be a particularly useful wavelength for the treatment of a wide variety of retinal lesions because it is not absorbed in xanthophyll and penetrates opacities of the optic media better than argon blue green. Furthermore, it is absorbed maximally in hemoglobin, making it particularly suitable for the coagulation of blood vessels.

Automatic phase-matched frequency-doubling system for the 240-350-nm region

An automatic frequency-doubling system has been constructed using a lithium formate monohydrate crystal as the frequency doubler in a stationary optical arrangement. Without any readjustment of the crystal orientation, smooth tuning of the uv light over the 240-350-nm range has been obtained. The feasibility of this system for uv absorption measurements has been successfully demonstrated using S0(2) gas.