Abstract
The brachial artery is the commonest artery injured in the extremities. Although the patients present late, nevertheless reconstructions is advocated in other to salvage the limb and maintain function of the hand. We retrospectively examined 25 consecutive patients with vascular injuries treated at The Cardiovascular and Thoracic Surgery Unit of a tertiary health centre over a period of 4 years. We assessed the pre-tertiary methods of stopping of bleeding injured brachial arteries, mechanisms of injury, associated injuries, treatment and the outcome following vascular repair in terms of functionality of the forearm and the volume of the radial pulsation. A total of 12 patients (48.0%) had brachial artery injuries out of the 25 patients with different forms of vascular injuries during the period. There were 10 males and 2 females, aged 7.5-65 years. The aetiology of the brachial artery injuries were: Glass cut in 5 patients, knife cut in 3 patients, surgical complication of tendon release (iatrogenic) in 1 patient, injury from self injection of pentazocine in 1 patient, machete cut in 1 patient and blunt vascular injury from fan belt injury in 1 patient. Except for the young girl whose brachial artery was injured at surgery, and had lateral repair done within 3hours, the timing between injury and repair in the remaining 11 patients ranged between 6-288 hours. This was beyond the golden time in trauma cases. Two patients had the brachial artery revascularised using the Reversed Saphenous Vein Graft (RSVG). The wrist pulsation was small volume in one patient as felt by palpation before discharge though the forearm was viable. Otherwise the remaining patients’ outcome was good. Most of the patients with brachial artery injury present late following injury. Revascularisation beyond the golden hour is still desirable as it will help to prevent limb loss. Plans should be put in place to train vascular surgeon to encourage prompt and expertise care.
Highlights
Vascular injuries in the country pose a great deal of distress to patients as a result of dearth of vascular surgeons to deal with the challenge [1]
The aetiology of the brachial artery injuries were: Glass cut in 5 patients, knife cut in 3 patients, as a surgical complication during tendon release in 1 patient, injury from self injection of pentazocine in one patient, machete cut in 1 patient and blunt vascular injury from fan belt injury in 1 patient. (Diagram 1-4)
It was only the young girl whom the brachial artery was injured at surgery who had lateral repair done within 3 hours while the time interval between brachial artery injury and repair in the remaining 11 patients ranged between 6-288 hours
Summary
Vascular injuries in the country pose a great deal of distress to patients as a result of dearth of vascular surgeons to deal with the challenge [1]. This is more often than not, leads to delayed presentations for specialist care [2,3] with a poor outcome. It is advocated that prompt repair be effected as this is necessary for the survival of the patient and salvage of the limb [5]. Patients with traumatic brachial artery injury have delayed referral to the tertiary centres for arterial reconstruction in our practice. We review the early outcome of delayed surgical reconstruction of brachial artery injuries in these patients. The essence of vascular surgery is to save limb and preserve function
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