Clinical Example: Branched subscapular arterial graft for popliteal artery reconstruction and banjo tuning peg assisted fasciotomy wound closure

This gentleman developed popliteal artery thrombosis after a closed knee dislocation and closed reduction. A segment of the subscapular arterial system was used to provide a small, tapering, branched arterial graft.

The calf fasciotomy site was progressively closed with a heavy prolene suture tightened with a banjo string tuning peg anchored to the patient's cast.

 
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Subscapular artery graft harvest
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The subscapular graft
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Branched reconstruction of popliteal pranches to anterior and posterior tibial arteries.
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Fasciotomy wound: initial attempts at progressive closure with staples and vessel loops were thwarted by repeated breaking of the elastics (below).
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After the patient had healed enough for casting, the wound was progressively closed with a running intradermal prolene attached to a banjo tuning peg which was tightened over the course of days.
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Final closure at the bedside with staples
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