Brachial artery injuries - the impact of the anatomical site of injury on postoperative outcomes

Abstract

Background:The start of the armed conflicts in Libyan society in 2011 led to a dramatic increase in the incidences of unusual types of brachial artery injuries, which were previously uncommon. In this study, the postoperative outcomes have been compared prospectively between patients who have had injuries at the proximal anatomical half of the brachial artery with those who suffered injuries at the distal anatomical half. Methods: A cohort study was undertaken to compare patients who had an injury at the proximal anatomical half of the brachial artery (considered as the first group) and patients who had an injury at the distal anatomical half of the brachial artery (considered as the second group). This was undertaken to analyse the influence of the anatomical site of injury on the postoperative outcomes in patients who underwent urgent surgical repair procedures at the hospital from February 2011 to December 2016. Results: Out of fifty-one patients, 31 (60.8%) patients had gunshot injuries, 12 (23.5%) had explosive injuries, four (7.8%) had stab wounds and four (7.8%) were victims of road traffic accidents. There were 13 (25.5%) patients in the first group and 38 (74.5%) patients in the second group. Three patients (5.9%) had postoperative arterial occlusion due to thrombosis, while two (3.9%) had postoperative graft occlusion due to thrombosis; the other two (3.9%) had compartment syndrome. Conclusion:Based on the anatomical background, critical limb ischaemia and postoperative ischaemic complications, as well as delayed limb amputation, are more associated with the injuries to the proximal anatomical half of the brachial artery due to poor collateral circulation at this level.

Brachial artery injury in a referral center in central Mexico

“…It communicates with the collateral circulation of the forearm through collateral and recurrent ulnar arteries. Due to this, there is a low percentage of limb loss despite the delay in treatment, since the degree of ischemia depends on whether the lesion is proximal or distal to the profunda brachial artery [11][12][13][14] . This explains why none of the patients we reported, who, despite having more than 6 hours of evolution, did not present any irreversible ischemia requiring amputation and revascularization was successful in all cases.…”

From the Editor's Desk

“…We are privileged to present two interesting articles on this critical area. The first looks at the intricate management of gunshot wounds to the abdomen and pelvis and addresses the complexities and challenges that such traumatic events (1). The second article focuses on surgical notes in emergency surgery and highlights the critical role of education in this documentation in emergency situations (2).…”