Abstract

Introduction: Elbow dislocations are sometimes associated with neurovascular injuries where brachial artery is the most frequently injured artery requiring emergency and adequate often complex surgical treatment in order to manage their severe complications.  The literature consists of only a few limited case reports on associated vascular or neurovascular injuries resulting from this type of trauma with no reference to the particular techniques we combined to treat our patient.

Presentation of Case: We present a Brachial Artery reconstruction in a 31-year-old patient with an Open Complex Right Elbow Dislocation. In the Clinical and Surgical Examination an open wound in the Anterior-Medial Right Antecubital Fossa presented with accompanying Brachial Pedicle all structures Transection was confirm. To repair the Brachial Artery a Substitution By-Pass and End-to-End Anastomosis was conducted using an Autologous Reverse Brachial Vein Conduit graft from the ipsilateral arm under General Anesthesia. For the Wound Closure a Rotational Skin and subcutaneous Fat Flap Graft. Postoperative patient progress, it was successful developing no Systemic Complications nor Ischemic Signs in the Right Upper Limb being discharge for Out-Patient follow-up once the Surgical Wound conditions allowed and a Duplex-Ultrasound on late postoperative confirm normal blood flow conditions through the By-pass and distal limb.

Discussion: In our patient Restoration of Brachial Veins continuity and blood flow it was impossible because of external resources related factors and then Brachial Veins Ligation decided, based on what our next decision was to preserve the Basilic and Cephalic Veins for Upper Limb Collateral Venous Return harvesting a segment of one Brachial Vein long enough as conduit for the Arterial By-Pass instead the Great Saphenous Vein which would imply unnecessary delay in the procedure. By the other hand we use a Rotational Skin and subcutaneous Fat Flap Graft for wound closure ensuring proper coverage of the conduit and no compartment increased pressure.

Conclusion: This approach of Brachial Artery and Neurovascular Pedicle Traumatic Transection can be technically conducted with success and a non-reparable Brachial Vein used as autologous by-pass conduit preserving Superficial Upper Limb Venous network to avoid perfusion compromise because of Deep Veins Ligation in a setting of no possible Deep Vein repair.

Keywords: Brachial Artery Trauma; Brachial Vein Trauma; Brachial Vein Ligation; Autologous By-Pass; Opened Elbow Dislocation; Rotational Flap Graft

References

1. Josefsson Per Olof and Bo E Nilsson. "Incidence of Elbow Dislocation". Acta Orthopaedica Scandinavica6 (1986): 537-538.
2. Hildebrand Kevin A., et al. "Acute Elbow Dislocations". Orthopedic Clinics of North America1 (1999): 63-79.
3. Lasanianos Nikolaos and Christos Garnavos. "An Unusual Case of Elbow Dislocation". Orthopedics8 (2008): 1-3.
4. Platz Andreas., et al. "Posterior Elbow Dislocation with Associated Vascular Injury After Blunt Trauma". The Journal of Trauma: Injury, Infection, and Critical Care5 (1999): 948-950.
5. MT Mercadante. "Protocolo De Manuseio Da Luxacãotraumática Aguda De Cotovelo”. Revista Brasileira De Ortopedia 38 (2003): 402-406.
6. Endean Eric D., et al. "Recognition of Arterial Injury in Elbow Dislocation". Journal of Vascular Surgery3 (1992): 402-406.
7. Ayel J-E., et al. "Acute Elbow Dislocation with Arterial Rupture. Analysis of Nine Cases". Orthopaedics and Traumatology: Surgery and Research 5 (2009): 343-351.
8. Martin Benjamin D., et al. "Complications Related to Simple Dislocations of The Elbow". Hand Clinics1 (2008): 9-25.
9. Miyazaki Alberto Naoki., et al. "Brachial Artery Injury Due to Closed Posterior Elbow Dislocation: Case Report". Revista Brasileira De Ortopedia2 (2016): 239-243.
10. Seidman Glen D and Paul A. Koerner. "Brachial Artery Rupture Associated with Closed Posterior Elbow Dislocation". The Journal of Trauma: Injury, Infection, and Critical Care2 (1995): 318-321.
11. Englert Carsten., et al. "Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations". Advances in Orthopedics 2013 (2013): 1-11.
12. Josefsson PO., et al. "Surgical Versus Non-Surgical Treatment of Ligamentous Injuries Following Dislocation of The Elbow Joint. A Prospective Randomized Study”. The Journal of Bone and Joint Surgery4 (1987): 605-608.
13. Mehlhoff TL., et al. "Simple Dislocation of The Elbow In The Adult. Results After Closed Treatment”. The Journal of Bone and Joint Surgery2 (1988): 244-249.
14. Padayachy V., et al. "A Retrospective Review of Brachial Artery Injuries and Repairs-Is It Still A “Training Artery". Injury9 (2010): 960-963.
15. Schmidt Robert D. "Traumatic Injuries of The Brachial Artery". The Journal of Emergency Medicine1 (1990): 105.
16. Ekim Hasan and Mustafa Tuncer. "Management of Traumatic Brachial Artery Injuries: A Report On 49 Patients". Annals of Saudi Medicine2 (2009): 105-109.
17. Kim John YS., et al. "Risk Factors for Compartment Syndrome In Traumatic Brachial Artery Injuries: An Institutional Experience In 139 Patients". The Journal of Trauma: Injury, Infection, and Critical Care6 (2009): 1339-1344.
18. Hunt charles A and John R kingsley. "Vascular Injuries of The Upper Extremity". Southern Medical Journal5 (2000): 466-468.
19. Bonnevialle P., et al. "Luxations Traumatiques Du Genou Associées À Une Interruption De L’Artère Poplitée". Revue De Chirurgie Orthopédique Et Réparatrice De L'appareil Moteur8 (2006): 768-777.
20. Shukla Dave R and Michael Hausman. "Surgical Management of Congenital Elbow Instability: A Case Report". Journal of Shoulder and Elbow Surgery4 (2016): e104-e109.
21. Zellweger R., et al. "An Analysis Of 124 Surgically Managed Brachial Artery Injuries". Journal of Vascular Surgery2 (2005): 372.
22. Franz Randall W., et al. "A Five-Year Review Of Management Of Upper-Extremity Arterial Injuries At An Urban Level I Trauma Center". Annals of Vascular Surgery5 (2012): 655-664.
23. Myers Stuart I., et al. "Complex Upper Extremity Vascular Trauma in An Urban Population". Journal of Vascular Surgery3 (1990): 305-309.
24. Vlsser Philip A., et al. "Prognosis Of Nerve Injuries Incurred During Acute Trauma To Peripheral Arteries". The American Journal of Surgery5 (1980): 596-599.
25. Sparks Steven R., et al. "Arterial Injury In Uncomplicated Upper Extremity Dislocations". Annals of Vascular Surgery2 (2000): 110-113.
26. Polat Gökhan., et al. "Pediatric Open Elbow Dislocation Without Fracture: A Case Report". International Journal of Surgery Case Reports12 (2014): 1064-1067.
27. Nazli Yunus., et al. "Brachial Artery Transection Associated with Open Elbow Dislocation In A 12-Year-Old: A Case Report". Vascular1 (2011): 27-30.
28. Ahmad R., et al. "Open Dislocation of The Elbow with Ipsilateral Fracture Of The Radial Head And Distal Radius: A Rare Combination Without Vascular Injury". Emergency Medicine Journal 12 (2007): 860-860.
29. Redjil Noureddine., et al. "Open Elbow Dislocation Associated with Distal Ischemia in Children About One Case and Review of The Literature". Pan African Medical Journal (2015).
30. Nagre SurajWasudeo. "Brachial Artery Injury Management: Case Series". Indian Journal of Vascular and Endovascular Surgery1 (2016): 7.
31. Marcheix Bertrand., et al. "Transection of The Brachial Artery After Closed Posterior Elbow Dislocation". Journal of Vascular Surgery6 (2005): 1230-1232.
32. Rich Norman M., et al. “Vascular Trauma”. Elsevier Saunders (2004).
33. Hardin WD., et al. "Traumatic Arterial Injuries of The Upper Extremity: Determinants of Disability". The Journal of Trauma: Injury, Infection, and Critical Care5 (1986): 490.
34. Grimer RJ and S Brooks. "Brachial Artery Damage Accompanying Closed Posterior Dislocation of The Elbow". The Journal of Bone and Joint Surgery3 (1985): 378-381.
35. Fields Charles E., et al. "Brachial and Forearm Vessel Injuries". Surgical Clinics of North America1 (2002): 105-114.
36. Boretto Jorge G., et al. "Comparative Study of Simple and Complex Open Elbow Dislocations". Clinical Orthopaedics and Related Research7 (2014): 2037-2043.
37. Iordens Gijs IT., et al. "Early Mobilisation Versus Plaster Immobilisation of Simple Elbow Dislocations: Results of The Funcsie Multicentre Randomised Clinical Trial". British Journal of Sports Medicine6 (2015): 531-538.
38. Dickens Jonathan F., et al. "Risk Factors for Decreased Range of Motion and Poor Outcomes in Open Periarticular Elbow Fractures". Injury4 (2015): 676-681.
39. Doody O., et al. "Extremities-Indications and Techniques for Treatment of Extremity Vascular Injuries". Injury11 (2008): 1295-1303.
40. Louis Dean S., et al. "Arterial Injury". The Journal of Bone and Joint Surgery8 (1974): 1631-1636.
41. Orcutt Michael B., et al. "Civilian Vascular Trauma of The Upper Extremity". The Journal of Trauma: Injury, Infection, and Critical Care1 (1986): 63-67.
42. Bongard Fred S., et al. "Management Strategy of Complex Extremity Injuries". The American Journal of Surgery2 (1989): 151-155.
43. Howard AC., et al. "Transection of The Brachial Artery Complicating Closed Posterior Dislocation of The Elbow". Injury3 (1991): 240-242.
44. Timberlake Gregory A., et al. "Venous Injury: To Repair or Ligate, The Dilemma". Journal of Vascular Surgery6 (1986): 553-558.
45. Williams Timothy K and W Darrin Clouse. "Current Concepts in Repair of Extremity nous Injury". Journal of Vascular Surgery: Venous and Lymphatic Disorders2 (2016): 238-247.
46. Spahos T and F Torella. "The Basilic Vein: An Alternative Conduit for Complex Iliofemoral Reconstruction". European Journal of Vascular and Endovascular Surgery4 (2012): 457-459.
47. Kim Hyunyoung G., et al. "Brachial Artery Repair Using the Basilic Vein as A Reliable Conduit In A 3-Year-Old Child". Journal of Pediatric Surgery Case Reports 19 (2017): 16-18.
48. Park Dae-Joon., et al. "Lower Extremity Arterial Bypass with Arm Vein Conduits and Literature Review". Vascular Specialist International4 (2016): 160-165.
49. Prichayudh Supparerk., et al. "Management of Upper Extremity Vascular Injury: Outcome Related to The Mangled Extremity Severity Score". World Journal of Surgery4 (2009): 857-863.
50. Feliciano David V and Steven R Shackford. "Vascular Injury: 50Th Anniversary Year Review Article of The Journal of Trauma". The Journal of Trauma: Injury, Infection, and Critical Care 4 (2010): 1009-1013.
51. Rozycki Grace S., et al. "Blunt Vascular Trauma in The Extremity: Diagnosis, Management, And Outcome". The Journal of Trauma: Injury, Infection, and Critical Care5 (2003): 814-824.
52. Gabrysz-Forget Fanny., et al. "Free Versus Pedicled Flaps for Reconstruction of Head and Neck Cancer Defects: A Systematic Review". Journal of Otolaryngology - Head and Neck Surgery 1 (2019).
53. Rodriguez-Collazo Edgardo., et al. "A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction". International Journal of Orthoplastic Surgery2 (2018): 1-12.
54. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference NY (1946): 19-22.
55. Camara Phyllis Jones., et al. "Addressing the Social Determinants of Children’S Health: A Cliff Analogy". Journal of Health Care for The Poor and Underserved 4A (2009): 1-12.
56. Adler Nancy E., et al. "Socioeconomic Status and Health: The Challenge of The Gradient”. American Psychologist1 (1994): 15-24.
57. Daniel Hilary., et al. "Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper". Annals of Internal Medicine 8 (2018): 577.

Citation

Citation: Yuniel Hernandez Castillo. "Use of A Brachial Vein Conduit and A Rotational Skin Flap Graft Repairing A Vascular Trauma".Acta Scientific Medical Sciences 4.1 (2020): 14-21.

Copyright

Copyright: © 2020 Yuniel Hernandez Castillo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.