Nerve injuries of the upper extremity associated with vascular trauma—surgical treatment and outcome

Abstract

Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is a high chance of combined injuries of these structures (23 %). The aim of our study is to describe and analyze associated nerve and vascular injuries of the upper extremity in patients treated at the Clinic of Neurosurgery in Belgrade over a 10-year period. This study included 83 patients that received surgical treatment at the Clinic of Neurosurgery in Belgrade after having been diagnosed with upper extremity nerve injury. The study included all patients that satisfied these criteria over a period of 10 years. The patients with associated vascular injuries, 36 of them, were considered our study group, while 47 patients without associated vascular injuries were considered our control group. Finally, we compared treatment outcome between these groups. The final outcome evaluation was performed 2 years after surgical treatment. In our study group, 84.8 % surgical nerve repair was successful (fair, good, and excellent outcome), while in the control group (patients without vascular injury), surgical nerve repair was successful in 87.9 %. The overall satisfactory neurological outcome (M3-M5) was present in 86.6 % of nerve repairs. Our study shows that there is no significant difference between the treatment outcome in patients with associated nerve and vascular injuries and patients with isolated nerve injuries if they are diagnosed in time and treated appropriately. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team.

Surgical Treatment of Radial Nerve Injuries Associated With Humeral Shaft Fracture—A Single Center Experience

“…Due to the close topographic ties between nervous, bony and vascular tissues ( 1 , 11 ), the injuries of peripheral nerves are often associated with these injuries ( 12 – 14 ), and radial nerve injuries occur in between 2 and 18% of cases with humeral shaft fracture ( 15 – 19 ). This high rate of combined injuries is probably due to their close anatomic relation in the spiral groove (sulcus nervi radialis - SNR) at the posterior side of the humeral shaft, as well as due to the rigidity of the radial nerve while piercing the lateral intermuscular septum after exiting the groove ( 20 – 22 ).…”

Subclavian-Brachial Bypass for Chronic Limb Threatening Ischemia Associated with an Old Motorcycle Accident

“…All patients with blunt UE trauma and accompanying risk factors must undergo vascular exploration to identify potential arterial injury. Persistent nerve damage and loss of function experienced by patients with blunt trauma and vascular injury may be due to the formation of perineural hematomas that can cause aseptic nerve injury, inflammation, and compartment syndrome [ 12 , 13 ].…”

Avaliações do lúmen da artéria reparada em lesões do antebraço usando o teste de Allen, Doppler portátil e ultrassonografia com Doppler

“…5,12 As causas da trombose do vaso ainda não são bem compreendidas, mas acredita-se que a pressão retrógrada no arco palmar provoca turbulência vascular e diminui o fluxo na artéria reparada, levando à sua obstrução. 13,14 Como a epidemiologia relatada por outros estudos, em nossa amostra, a maior prevalência de lesões arteriais no antebraço foi observada em pacientes jovens do sexo masculino.…”

“…As causas da trombose do vaso ainda não são bem compreendidas, mas acredita-se que a pressão retrógrada no arco palmar provoca turbulência vascular e diminui o fluxo na artéria reparada, levando à sua obstrução. 13 14…”