Axillary Hematoma Research Articles

Verletzung der A. subscapularis durch Reposition einer vorderen Schulterluxation

Anterior shoulder dislocations are one of the most common problems seen in an emergency department. Doubtless, immediate reduction is necessary for treatment, a procedure that is extremely rarely accompanied by complications. In these cases early diagnosis and treatment may be limb saving. We report a case with rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation with formation of an axillary hematoma and consecutive paresis of the plexus brachialis. Interdisciplinary operative revision was necessary to remove the hematoma, stop the hemorrhage and for neurolysis of the plexus brachialis. Treatment resulted in a speedy recovery of the patient. Gentle reduction of a dislocated shoulder is a prerequisite for a low complication rate. Contrast-enhanced computed tomography facilitated diagnosis of the hematoma and identification of the bleeding vessel.

Efficacy and safety of axillary brachial plexus block for operations on the hand

An axillary brachial plexus nerve block by a transarterial approach is commonly used to achieve regional anaesthesia for hand surgery. We designed a retrospective study to evaluate efficacy and safety of the technique for acute and elective operations. Anaesthetic records of 189 of all 5520 patients (1996-2000) who had axillary brachial plexus blocks for hand surgery were reviewed, and results compared with complications recorded in the anaesthetic register and in the hand surgery records. Successful axillary block was achieved in 5128/5520 (93%) of patients, according to anaesthetic charts, and primarily in 157/189 (83%), and after supplementation in 171/189 (90%), according to anaesthetic records. Four patients had a toxic drug reaction or axillary haematoma with a transient neurological deficit. Medical complications were recorded in the anaesthetic register in less than 0.7% of axillary brachial plexus procedures. Axillary brachial plexus block by a transarterial approach is effective and safe in hand surgery.

Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma

Post-mastectomy pain syndrome (PMPS) is experienced by 20–65% of patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome is unclear and most likely multi-factorial. Symptoms may be mild, not requiring treatment, or severe, considerably restricting quality of life. The effectiveness of available pharmacological and pain management therapies is unknown. Certainly, some women remain under-treated with poor pain control. We report three women undergoing wide local excision for cancer of the breast and block dissection of axillary lymph nodes who subsequently developed severe PMPS. In these cases the symptoms were completely relieved by the aspiration or formal drainage of an encapsulated haematoma in the axilla. The removal of a minimal amount of blood brought instant improvement suggesting that pressure within the haematoma could be an etiological factor. An axillary haematoma, which may not be clinically obvious, should be considered as a possible cause of PMPS.

Axillary artery transection following anterior shoulder dislocation: classical presentation and current concepts

Injury to the axillary artery following anterior shoulder dislocation is a very rare occurrence. This review serves to illustrate the now classical case of an elderly gentleman with a recurrent dislocation, transection of the axillary artery and its invariable association with a severe brachial plexus lesion, which is the most important determinant of long-term disability. It also highlights the pathognomic triad of anterior shoulder dislocation, expanding axillary haematoma and diminished peripheral pulse, to highlight awareness of this important injury. The literature on this injury has been reviewed and recommendations for the immediate and early post-operative investigation and management have been brought up to date in line with current thinking.

Neurologic complications of 405 consecutive continuous axillary catheters.

Continuous axillary brachial plexus block may theoretically increase the risk of neurologic complications because of catheter-induced mechanical trauma or local anesthetic toxicity. In this study, we retrospectively reviewed the frequency of complications using current techniques and applications. There were 405 continuous axillary catheters in 368 patients. A preexisting neurologic condition was present in 41 (10.1%) patients, including 30 patients with a preoperative ulnar neuropathy. In 305 (75.3%) cases, the axillary catheter was placed to facilitate rehabilitation after major elbow surgery. Catheters were typically placed postoperatively, after documentation of the patient's normal neurologic examination. The local anesthetic infusion contained bupivacaine in 355 (88.7%) patients and mepivacaine in 45 (11.1%) patients. The mean infusion rate was 10 +/- 2 mL/h. Catheters remained indwelling for 55 +/- 32 h. In 31 patients, the axillary catheter was replaced because of technical problems or inadequate analgesia. There were 9 complications in 8 patients for an overall frequency of 2.2%. Complications included one each of the following: localized infection (treated with catheter removal and antibiotics), axillary hematoma, and retained catheter fragment requiring surgical excision. In addition, two patients reported signs and symptoms of systemic (preseizure) local anesthetic toxicity. Four (1.0%) patients reported new neurologic deficits postoperatively. In two patients, the neural dysfunction was non-anesthesia related. All four had continuous catheters placed after major elbow surgery. We conclude that the risk of neurologic complications associated with continuous axillary blockade is similar to that of single-dose techniques. We evaluated the risk of neurologic complications in 368 patients undergoing 405 consecutive continuous axillary blocks. New neurologic deficits were reported in four patients. This series suggests that the risk of neurologic complications associated with continuous axillary block is similar to that of single-dose techniques.

Axillary block complicated by hematoma and radial nerve injury

Background and Objectives. Hematoma is typically cited as one mechanism of nerve injury following axillary block. However, documented cases of this are lacking. Methods. A healthy 38-year-old man was scheduled for surgical removal of a tumor of the hand. A transarterial axillary block was performed with a 22-gauge short-bevel needle using 40 mL of a mixture of equal volumes of 1.5% lidocaine and 0.5% bupivacaine containing 1:200,000 epinephrine. No paresthesias were reported. Post-operative, the patient developed a large axillary hematoma accompanied by paresthesias and radial nerve weakness. Results. With conservative management, nerve recovery was complete in 6 months. Conclusions. Hematoma complicating axillary block may result in nerve dysfunction.

Hématome compressif compliquant le cathétérisme percutané de la veine axillaire

A 41-year-old woman was admitted in the intensive care unit with ruptured oesophageal varices. She had already had two similar events, six and four months previously. She had a haemoglobin concentration of 56 g · 1 −1, 20 % prothrombin, 228 s activated cephalin time for a control time of 60 s, 0.9 g · 1 −1 of fibrinogen and a platelet count of 53 G · 1 −1. Because of the poor condition of her peripheral veins, it was decided to insert a central venous catheter. The axillary vein was chosen because of the coagulopathy. The axillary artery was accidentally punctured during the second attempt. Despite manual compression for 15 min, a small haematoma arose. The catheter was inserted in the right internal jugular vein. At the same time, a very large oedema of the left arm was noticed. The axillary haematoma had spread to the breast and lumbar fossa. The humeral and radial pulse amplitudes were decreased, and the patient complained of paraesthesiae. At phlebography, a vast haematoma was seen to compress the axillary vein. The patient's condition rapidly worsened, and she died 19 hours after admission with a probable cerebral haemorrhage. Although complications of axillary venous catheterization are rare, this case demonstrates that, in patient with very abnormal coagulation tests, central venous access should be obtained via a peripheral vein.

Analysis of cosmetic results and complications in patients with stage i and ii breast cancer treated by biopsy and irradiation

Between May, 1973 and December, 1980, 78 Stage I and 11 breast carcinomas in 76 patients were treated by biopsy and radiotherapy with curative intent. With a maximum follow-up of 10 years, a minimum of 2 1 2 years and a median follow-up of 3'/z years, a loco-regional control rate of 97% was obtained. Cosmetic results and treatment complications were studied. Patient characteristics, tumor size, excisional biopsy technique, axillary staging procedure and radiotherapy techniques were analyzed and all found to be important factors affecting cosmesis and complications. The most common complications included transient breast edema observed in 51 % of patients, breast fibrosis (usually mild) seen in 23 % of the population, axillary hematoma or seroma formation in 15 %, mild arm edema in 14% and basilic vein thrombosis in 10% of patients. The causes of these and other less frequent complications are discussed. The overall cosmetic result was excellent in 78%, satisfactory in 18% and unsatisfactory in 4 % of patients. Recommendations for improving cosmetic results and minimizing complications are made. In our prospective trial, the high loco-regional control and good cosmesis supports the use of excisional biopsy and radiation therapy in patients with Stages I and 11 breast carcinoma.