Casal Diogo, Cunha Teresa, Pais Diogo, Iria Inês, Angélica-Almeida Maria, Millan Gerardo, Videira-Castro José, Goyri-O'Neill João
Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
J Med Case Rep. 2017 Jan 4;11(1):6. doi: 10.1186/s13256-016-1162-6.
Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a brachial plexus injury in which the urgency of the situation precluded the use of any ancillary diagnostic examinations and forced a rapid clinical assessment.
We report a case of a Portuguese man who had a stabbing injury at the base of his left axilla. On observation in our emergency room an acute venous type of bleeding was present at the wound site and, as a result of refractory hypotension after initial management with fluids administered intravenously, he was immediately carried to our operating room. During the course of transportation, we observed that he presented hypoesthesia of the medial aspect of his arm and forearm, as well as of the ulnar side of his hand and of the palmar aspect of the last three digits and of the dorsal aspect of the last two digits. Moreover, he was not able to actively flex the joints of his middle, ring, and small fingers or to adduct or abduct all fingers. Exclusively relying on our anatomical knowledge of the axillary region, the site of the stabbing wound, and the physical neurologic examination, we were able to unequivocally pinpoint the place of the injury between the anterior division of the lower trunk of his brachial plexus and the proximal portion of the following nerves: ulnar, medial cutaneous of his arm and forearm, and the medial aspect of his median nerve. Surgery revealed a longitudinal laceration of the posterior aspect of his axillary vein, and confirmed a complete section of his ulnar nerve, his medial brachial and antebrachial cutaneous nerves, and an incomplete section of the ulnar aspect of his median nerve. All structures were repaired microsurgically. Three years after the surgery he showed a good functional outcome.
We believe that this case report illustrates the relevance of a sound anatomical knowledge of the brachial plexus in an emergency setting.
尽管涉及臂丛神经的开放性损伤相对少见，但如果伴有血管损伤，可能导致永久性残疾，甚至危及生命。我们报告一例臂丛神经损伤病例，由于情况紧急，无法进行任何辅助诊断检查，只能进行快速临床评估。
我们报告一例葡萄牙男子，其左腋窝底部被刺伤。在我们的急诊室观察时，伤口处出现急性静脉出血，经静脉补液初步处理后仍顽固性低血压，遂立即送往手术室。在转运过程中，我们发现他的手臂和前臂内侧、手部尺侧、最后三个手指的掌侧以及最后两个手指的背侧感觉减退。此外，他无法主动屈曲中指、环指和小指的关节，也无法内收或外展所有手指。仅依靠我们对腋窝区域的解剖知识、刺伤部位以及体格神经检查，我们能够明确指出损伤部位在其臂丛神经下干前支与以下神经的近端之间：尺神经、臂内侧皮神经、前臂内侧皮神经以及正中神经内侧部分。手术发现其腋静脉后壁有纵向撕裂，并证实尺神经、臂内侧皮神经和前臂内侧皮神经完全离断，正中神经内侧部分不完全离断。所有结构均进行了显微外科修复。术后三年，他的功能恢复良好。
我们认为本病例报告说明了在紧急情况下掌握臂丛神经扎实解剖知识的重要性。
