engleski

Axillary neurovascular injury caused by penetrating trauma

AXILLARY NEUROVASCULAR INJURY CAUSED BY PENETRATING TRAUMA Đaković Bacalja I., Koprek D. ABSTRACT Purpose: A penetrating axillary trauma is rare for its natural protection by the bones and muscles of the shoulder girdle.1 We report a case of a patient suffering axillary neurovascular penetrating trauma. Methods and results: A 67-year-old man had fallen in a ground level on his back and sustained a stabbing wound to the left axilla by the scissors from his pocket. He was admitted to our emergency unit with signs of haemorrhagic shock. Motor and sensory deficit of the left hand was evident. He underwent initial emergency surgery with successful vascular repair of the axillary artery with interposition polytetrafluoroethylene (PTFE) 7mm graft. Veins had to be ligated for the major defect, including axillary veins. The wound was drained with Redon drain. Brachial plexus injury was confirmed by the neurological exam and magnetic resonance imaging (MRI) and is planned for the secondary surgery. The MRI revealed a significant haematoma next to axillary artery and the brachial plexus. 7 days after the surgery, the patient had symptoms of paraesthesia and a decreasing oedema of the left hand. Conclusion: Traumatic vascular injuries in axillary region are rare and reconstruction of the injured axillary artery is technically very demanding concerning complexity of the anatomical region, risk of retraction of axillar artery to thorax, proximity of the blood vessels and nerves in this region and the lack of surgical experience with deep traumatic axillary injuries. In our case, sacrificing axillary veins proved to be safe in case of large defects of veins with no significant repercussions. The urgent diagnosis and prompt revascularization are of vital importance. The axillary blood vessels lesions are often associated with brachial plexus lesion as well. After primary life and limb saving surgery, nerves damage can be surgically treated in a secondary act.

axillary trauma, vascular injuries, axillar artery

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