Okonta Kelechi Emmanuel, Ocheli Emmanuel Ossai, Gbeneol Tombari Joseph
Department of Surgery, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
Federal Medical Centre Owerri, Nigeria.
Pan Afr Med J. 2017 Jul 31;27:232. doi: 10.11604/pamj.2017.27.232.7291. eCollection 2017.
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.
肱动脉是四肢最常受伤的动脉。尽管患者就诊较晚，但仍主张进行重建手术以挽救肢体并维持手部功能。我们回顾性研究了一家三级医疗中心心血管和胸外科在4年期间连续治疗的25例血管损伤患者。我们评估了院前止血肱动脉损伤的方法、损伤机制、相关损伤、治疗以及血管修复后的前臂功能和桡动脉搏动情况等结果。在这25例不同形式血管损伤的患者中，共有12例（48.0%）发生了肱动脉损伤。其中男性10例，女性2例，年龄在7.5至65岁之间。肱动脉损伤的病因包括：玻璃割伤5例、刀割伤3例、肌腱松解手术并发症（医源性）1例、喷他佐辛自我注射致伤1例、大砍刀砍伤1例、风扇皮带钝性血管损伤1例。除了一名在手术中肱动脉受伤且在3小时内进行了侧方修复的年轻女孩外，其余11例患者受伤至修复的时间间隔在6至288小时之间。这超出了创伤病例的黄金时间。2例患者使用了大隐静脉逆行移植术（RSVG）进行肱动脉血运重建。出院前通过触诊发现1例患者腕部搏动较弱，尽管前臂存活。否则其余患者的预后良好。大多数肱动脉损伤患者受伤后就诊较晚。超过黄金时间进行血运重建仍然是可取的，因为这有助于防止肢体丧失。应制定计划培训血管外科医生，以鼓励及时和专业的治疗。
