Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.

Extraskeletal Chondroma in the Popliteal Region: A Case Report

EXTRASKELETAL chondroma is a rare benigntumor that usually develops in the soft tissue,which commonly occurs in the limbs of adults andgenerally presents as painless masses without thesurrounding tissues involvement. The diagnosis mainlydepends on computed tomography, magnetic resonanceimaging （MRI） examination, and postoperative pathologicalexamination. This paper reports a case of extraskeletalchondroma in the popliteal region.

Radiological Mimics of Popliteal Cysts: An Algorithmic Approach Using US and MRI to Identify the Potentially Malignant Lesions: Case Series

Background: Popliteal cysts are common and present as asymptomatic lumps in the medial popliteal fossa. Some have complex internal characteristics such as septa and loose-bodies. However, not all are popliteal cysts and can be aggressive. These lesions need to be differentiated by the absence of the communicating neck with the joint on ultrasound. Presence of Doppler flow of non-communicating cysts requires further evaluation on MRI, prior to performing a biopsy. Using a case series, we propose an algorithmic approach that is simple and will help identify the malignant lesions and institute appropriate management. Case-Presentation: Popliteal Cyst: On ultrasound: characteristic neck communicating with knee joint. Synovial Sarcoma: Gadolinium enhancement, with areas of low-, iso- and hyper-intense signal to fat on T2. Synovial-Osteochondromatosis: Non-mineralized: T1-low/intermediate intensity;T2-high intensity. Mineralized type: low intensity on T1 & T2. Thrombosed Popliteal Aneurysm: Lamellated appearance-high/low signal intensity on T2. Myxoid-Liposarcomas: Inhomogeneous appearance;homogenous with gadolinium. Usually require a biopsy for diagnosis. Conclusion: The cystic lesions in the medial aspect of the popliteal fossa can be misdiagnosed. Our article reiterates the importance of the communicating neck that separates popliteal cysts from other mimics. We have proposed an algorithm to identify these mimics.

Giant cutaneous squamous cell carcinoma of the popliteal fossa skin:A case report

BACKGROUND Cutaneous squamous cell carcinoma(cSCC)is a common malignant hyperplasia of the skin epithelium.However,cSCC progressing to giant squamous cell carcinoma of the popliteal fossa skin has not been reported.We used full-thickness skin graft from the lower left quadrant of the abdomen to reconstruct the popliteal fossa skin defect in our patient.CASE SUMMARY A 64-year-old woman presented with a 3-year history of a progressively enlarged integumentary tumor located on her left popliteal fossa,which was surgically treated.The resultant defect(15 cm×25 cm)was repaired using full-thickness skin graft from the lower left quadrant of the abdomen.CONCLUSION Full-thickness skin graft is a good choice to repair popliteal fossa defect.

Comparison of Time Development of the Sciatic Nerve Blockade Performed with 1% Lidocaine Subgluteal and Popliteal Approach under Ultrasound Guidance

The existing researches in the field of regional anesthesia of the sciatic nerve show that if popliteal sciatic nerve blockade is performed, the time of the development of the sciatic nerve anesthesia is longer in comparison with subgluteal sciatic nerve blockade. Background: The aim of the research is to compare the time of the development of the sciatic nerve blockade performed with 1% lidocaine with epinephrine (1:200,000) in subgluteal and popliteal areas under ultrasound guidance. Materials and Methods: Patients were divided into two groups. In Group A (20 patients), the subgluteal approach to block the sciatic nerve was taken;in Group B (20 patients), the popliteal approach was applied. All blockades of the sciatic nerve were performed with 1% lidocaine (30 ml of lidocaine with epinephrine (1:200,000)) and electrical stimulation of peripheral nerves under ultrasound guidance. We measured the time of the development of sensory and motor blocks. Results: In Group A, the sciatic nerve sensory block developed in 15 (14 - 16) minutes, a complete motor block developed in 15.5 (15 - 17) minutes. In Group B the sciatic nerve sensory block developed in 40 (38.5 - 42.5) minutes while a complete motor block did not develop in any patient. Conclusion: When the sciatic nerve is blocked in subgluteal area with 30 ml of 1% lidocaine with epinephrine (1:200,000) under ultrasound guidance, sensory blocks develop faster than during the popliteal blockade: 15 (14 - 16) minutes vs. 40 (38.5 - 42.5) minutes respectively. The opportunity to define the place of the introduction of local anesthetic in our research is limited.

Obstruction of a Popliteal Artery Stent of a Patient with Popoiteal Artery Entrapment Syndrome

We encountered a popliteal artery entrapment syndrome (PAES) patient who was treated with stent placement for popliteal artery without correcting an abnormal muscular structure that compresses popliteal artery in another institution. The popliteal artery stent was occluded one year after the stent placement. The patient was treated with bypass graft by reversed saphenous vein. Interventionists should be cautious with stent placements for popliteal artery without adjusting the anomalous musculotendinous structure in patients with PAES.

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx? with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites.

Unusual communication of profunda femoris vein with the popliteal vein in the middle of the popliteal fossa

Profunda femoris vein (PFV) rarely forms a direct communication with the lower end of the femoral vein (FV) or popliteal vein (PV). During regular dissections for medical undergraduates, we came across a rare anatomical variation of PFV in the right lower limb of an 80-year-old female cadaver. PFV commenced from the PV just above its formation by the union of anterior and posterior tibial veins. It traversed the popliteal fossa on the lateral side of the popliteal artery and entered into the adductor canal after piercing the adductor magnus muscle. Finally, it emptied into the FV in the lower part of the femoral triangle. Furthermore, the PV had a small caliber than that of PFV. Deep veins of leg are the common site for formation of thrombosis. In terms of diagnosis and operative procedures, the location of thrombosis in the deep veins of lower limb is clinically of great importance. Thus detailed knowledge of the anatomical variation reported here is useful during diagnosis and treatment of deep vein thrombosis.

Efficacy of Ultrasound-Guided Unidirectional Valve Enlargement in Treatment of Popliteal Cysts

Purpose: To investigate the effect of ultrasound-guided unidirectional valve cleft enlargement in the treatment of popliteal cysts. Methods: Forty-eight patients with popliteal cysts who met the inclusion criteria and were admitted to our hospital from December 2018 to June 2020 were randomly divided into group A (24 cases) and group B (24 cases). Group A was treated with a central venous catheter dilator, and group B was treated with traditional open surgery to remove the popliteal cyst. Visual analogue scale (VAS) was used to evaluate discomfort. The VAS, Lysholm score of knee joint and Rauschning-Lindgren grade 0~I improvement rate were compared at 6 months after operation. Results: The postoperative VAS in group A was significantly better than that in group B (P < 0.05), and the postoperative Lysholm score and Rauschning-Lindgren grade 0~I in group A were higher than those in group B (P < 0.05). There was no recurrence or other complications in either group. Conclusions: Ultrasound-guided central venous catheter dilator is more effective than traditional surgical resection of popliteal cysts.

Popliteal Artery Aneurysms

A popliteal artery aneurysm is defined as a dilation of the popliteal artery greater than 20 mm, or greater than 50% at diameter of the native artery. Popliteal artery aneurysms are rare, but are most common in the lower extremities. These aneurysms have a high risk of ischemic complications and amputations even in unoperated patients. We describe the case of a 54-year-old man, hypertensive, with a large popliteal artery aneurysm. Doppler ultrasound and CT angiography of the lower limbs showed a 100 × 80 mm aneurysm of the popliteal artery. This aneurysm is responsible for venous compression with edema of the tissues under the skin. The patient was treated and a flattening of the aneurysm associated with bypass by the inverted right internal saphenous vein taken from the ipsilateral leg was performed. The patient was discharged on the 6th day of the operation. The patient was seen again at the outpatient clinic for one month and in the 3rd month an arterial Doppler ultrasound of the lower limbs performed had shown patency of the venous graft and disappearance of the intermittent claudication.

Treatment of Popliteal Cyst through Radiofrequency Thermocoagulation under Ultrasound Guidance

Objective: The purpose of this study was to explore the clinical efficacy and security of the treatment of popliteal cyst through radiofrequency thermocoagulation (RFT) under ultrasound guidance. Methods: The clinical data of 35 patients with popliteal cyst, who were treated by RFT under ultrasound guidance from June 2019 to June 2020, were retrospectively analyzed. The Visual Analogue Scores (VAS) and the size of cyst before and after treatment were recorded at the first month, the third month, the sixth month. After six months, the recovery rate of Rauschning and Lindgren classification (R-L classification) level 0, 0 - I were counted. All the complications of the patients were observed. Results: 32 patients were followed up for six months. The scores and cyst sizes of each patient before and after the treatment were on a normal distribution curve. There was no significant difference in VAS scores before and after the treatment (P > 0.05). However, there was a significant difference in cyst sizes before and after the treatment (P < 0.05). Moreover, there was no significant difference in VAS scores and cyst sizes in each period after treatment (P > 0.05). According to the R-L classification in 6 months after treatment: the recovery rate of class 0 was 62.5% and class 0 - I level was 87.5%. There were no serious complications in the process. Conclusion: Treatment of popliteal cyst through RFT under ultrasound guidance is a simple, easy, reliable method that is worthy of clinical promotion.

Pterygium Popliteal Syndrome Concerning a Case in the Pediatric Surgery Department of the Donka National Hospital (Conakry CHU)

Introduction: Popliteal pterygium syndrome is a rare birth defect, combining craniofacial, genitourinary and musculoskeletal abnormalities. It is an autosomal dominant disease caused by a mutation in the IRF6 gene. We report in this observation the 1st Guinean case corrected by the surgical method as well as a review of the literature for a diagnostic and therapeutic approach. Patient and observation: We present the case of a 7-day old male newborn weighing 2700 g who was received for bilateral cleft lip and palate, lower lip fossa or sinuses, bilateral popliteal pterygium, and triangular skin fold above the hallux. The patient underwent several surgical procedures aimed at correcting these abnormalities. The correction of the pterygium of the lower limbs was ensured by excision of the fibrous band, the tenoplasty in z of the calcaneal tendon on the right side and the skin plasty in z in series then immobilized by plaster splints. The immediate postoperative follow-up was straightforward. Conclusion: Popliteal pterygium syndrome is a rare congenital malformation, the diagnosis is primarily clinical. Early soft tissue lengthening surgery and serial z-skin plasty provide better correction of the knee pterygium. Correct correction of facial abnormalities gives the child a better appearance. The management of this syndrome is multidisciplinary.

A Rare Presentation of Popliteal Vein Aneurysm: Case Report

Popliteal venous aneurysms (PVAs) are very rare. More often it is an incidental finding found on duplex ultrasonography. Venous thrombosis and pulmonary emboli is the primary presentation in most cases of PVAs, hence it is a clinically significant abnormality and a potentially morbid and fatal condition. Early surgical repair should be performed immediately after the diagnosis is made because of the risk of pulmonary emboli. We report a case of symptomatic PVA presenting primarily with local symptoms and chronic pain in popliteal region.

Outcomes of Open Surgery for Popliteal Artery Aneurysms:An 18-Year Experience in a Single Institution in Japan

Objective: To elucidate the outcomes of open surgery for popliteal artery aneurysm (PAA) in a single Japanese institution. Materials and Methods: Between 1999 and 2016, 35 patients (44 PAAs) underwent open surgery in our department. The first-line surgical strategy involved the medial approach, with excision of the aneurysm sac and autologous vein bypass grafting. Associations between the outcomes and 1) the surgical management of the aneurysmal sac (aneurysmectomy vs. ligation with bypass) and 2) the preoperative clinical symptoms were evaluated. Results: There were no aneurysm-related deaths during the follow-up period (mean, 4 years;range, 1 - 17.6 years). The 5-year primary, primary-assisted, and secondary patency rates were 67.9%, 72.7%, and 94.5%, respectively. Re-intervention was required for 19 PAAs (14 patients), including two PAAs in patients with suspected Beh&ccedil;et’s disease. Patency rates did not differ between the aneurysmectomy and ligation groups. Remnant sac enlargement occurred in 3 cases. Among asymptomatic patients, clinical symptoms did not deteriorate;however, the ankle brachial pressure index decreased ≥0.15 in patients with artery-graft mismatching. Conclusion: Patency rates were good, and our modified ligation with bypass procedure, which involves excising the sac as much as possible, exhibited less risk in terms of remnant sac enlargement compared to that in previous studies.

Clinical Application of Direct Skin Grafting Repair in Popliteal Scar Contracture after Burn in Children

Objective To observe the clinical application of direct skin grafting in repairing popliteal scar contracture after burn in children.Methods From April 2017 to January 2019,30 children with popliteal scar contracture after burn were selected as the research objects.The scar status,knee joint function and quality of life of the patients before and after the operation were compared by direct skin grafting after medium thickness skin removal.Results 30 patients were treated with skin grafting to repair popliteal scar contracture,27 patients healed well,and the survival rate of skin grafting reached 90.00%.The scores of postoperative scar and knee joint function scale(WOMAC)were lower than those before the operation,and the scores of concise health status scale(SF-36)were higher than those before the operation,with statistical significance(P<0.05).Conclusion Scar contracture of popliteal fossa after burn in children can be repaired by direct skin grafting in the skin extraction area after medium thickness skin cutting,which can effectively improve scar condition,restore knee joint function and significantly improve quality of life.

Impact of leg bending in the patient-specific computational fluid dynamics of popliteal stenting

Endovascular treatment of the femoro-popliteal artery has recently become a valuable therapeutic option for popliteal arterial aneurysms.However,its efficacy remains controversial due to the relatively high rate of complications,such as stent occlusion as result of intra-stent thrombosis.The elucidation of the interplay among vessel geometrical features,local hemodynamics,and leg bending seems crucial to understand onset and progression of popliteal intra-stent thrombosis.To this aim,patient-specific computational fluid dynamic simulations were performed in order to assess the intra-stent hemodynamics of two patients endovascularly treated for popliteal arterial aneurysm by stent-grafts and experiencing intra-stent thrombosis.Both Newtonian and non-Newtonian blood rheological models were considered.Results were presented in terms of tortuosity,luminal area exposed to low(<0.4 Pa)and high(>1.5 Pa)time-averaged wall shear stress(TAWSS),area exposed to high(>0.3)oscillatory shear index(OSI),and flow helicity.Study outcomes demonstrated that leg bending induced significant hemodynamic differences(>50%increase)in both patients for all the considered variables,except for OSI in one of the two considered patients.In both leg configurations,stent-graft overlapping induced a severe discontinuity of the lumen diameter where the proximal stented zone is characterized by low tortuosity,low velocity,low helicity,low TAWSS,and high OSI;while the distal part has higher tortuosity,velocity,helicity,TAWSS,and lower OSI.Sensitivity study on applied boundary conditions showed that the different inlet velocity profiles for a given inlet waveform affect slightly the numerical solution;conversely,the shape and magnitude of the prescribed inlet waveform is determinant.Focusing on the comparison between the Newtonian and non-Newtonian blood models,the area with low TAWSS is greater in the Newtonian model for both patients,while no significant difference occurs between the surfaces with high TAWSS.

Resolution of cystic adventitial disease of the popliteal artery after unsuccessful treatment of percutaneous transluminal angioplasty

Cystic adventitial disease （CAD） is a rare condition characterized by cyst!c lesions of the non-axial blood vessels adjacent to joints;j the majority of cysts are in the lower limb, with popliteal artery predominance. Here, we report a case of cystic adventitial disease in a 47-year-old man who was misdiagnosed and performed percutaneous transluminal angioplasty （PTA） in other hospital. He was eventually treated successfully with incision and evacuation of the popliteal cyst and ligation of communicating channels to the knee joint and remains asymptomatic 1 year later.

Management of Acute Lower Extremity Thrombosis Associated with Bilateral Popliteal Aneurysms Using Combined Thrombolytic Therapy and Stent Graft Repair

To the Editor：This is a brief clinical report on different endovascular procedures in the treatment of popliteal artery aneurysms （PAAs）.A 75-year-old man presented at the vascular clinic with progressive left lower limb pain at rest associated with coolness,pain,and paresthesia.His medical history was significant for hypertension and hyperlipidemia.The femoral and popliteal pulsations were only felt in the left limb.Coldness,pallor,paresthesia,delayed capillary refilling,and color changes were noted in the left limb together with rest pain.Duplex ultrasound was performed and an embolization （Rutherford Grade 2b） and bilateral PAAs were found,which on computed tomography angiogram （CTA） measured 62 mm and 82 mm with the maximum diameters in the right and left popliteal artery,respectively.Thrombus was found in both aneurysm sacs [Figure 1 a and b].Thromboembolism from the left PAA could be seen in the distal arteries.Other potentially associated aneurysms were excluded by magnetic resonance angiography.The erythrocyte sedimentation rate and C-reactive protein were moderately elevated,and thrombophilia profile was negative,and history for any orogenital ulcers was negative.

Design and mechanical properties testing of a new cross-helical popliteal artery stent

The popliteal artery has complex deformations such as axial shortening,bending,squeezing and twisting,as well as specific positions across the knee joint.Up to now there is a high incidence of in-stent restenosis(ISR)after the stent treatment of the popliteal artery.This paper aimed to design a new type of popliteal artery stent–crosshelical stent.to meet its deformation characteristics.The finite element analysis(FEA)method was used to test the mechanical properties of six stents with different winding height ratios of axial shortening,bending,plate extrusion,and torsional deformation.The results showed that the stents performance was affected by the ratio of winding height,the larger the winding height ratio,the worse the compliance,the worse the axial compressibility,but the better the radial support.And when the stent is torsional,the greater the winding height ratio is,the greater the stress is.In additon,the maximum stress was also related to the direction of torsion deformation,and the stress when the helix has the same direction with the torsion direction of the stent are was greater than that when the helix direction and torsion direction are opposite.Moreover,when the winding height ratio is 3:5,the performance of the stent is better,not only has better flexibility,its radial force,axial compression,and torsional deformation are better.It is concluded that the new cross-helical stent can adapt to the special deformation of popliteal artery and has good mechanical properties.

Van Der Woude综合征的遗传学分析

目的对4个VanderWoude综合征(VWS)家系和1个Poplitealpterygium综合征(PPS)家系进行进行遗传学分析。方法对以上家系进行临床表型观察,计算表型分布频率和表型基因频率。结果VWS表型分布频率为:腭裂或隐腭裂(82%),唇瘘(52%),缺牙(22%);表型基因频率约为1/50000。结论VanderWoude综合征表型变化可能是由于存在特定的修饰基因,进一步寻找修饰基因将为临床基因治疗和基因诊断提供分子基础。