Delayed brachial artery reconstruction after traumatic injury: a case for sustainment of surgical intervention

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.

Brachial artery injury in a referral center in central Mexico

“…The goal of treatment is the prevention of prolonged tissue ischemia and the salvage of the limb preserving the best functionality. Ideally, vascular repair should be performed within the first hour of injury presentation, however, most of these patients are referred after this time, so regardless of time, most patients benefit from delayed arterial revascularization to improve treatment functional prognosis of the limb 20 .…”

TLR4 knockdown by miRNA-140-5p improves tendinopathy: an in vitro study

“…Therefore, treatment of damaged tendons seems to be extremely important. Traditional tendon therapies mainly include currently used physical therapies, non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids [16][17][18]. However, their therapeutic effects are rather poor and their toxic and side effects may be rather serious.…”