Jordan Rebecca, Obmann Melissa, Song Boyoung, Nikam Shivprasad, Mariner David, Toy Frederick, Lopez Richard
Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America.
Trauma Case Rep. 2019 Aug 14;23:100236. doi: 10.1016/j.tcr.2019.100236. eCollection 2019 Oct.
Scapulothoracic dissociation is a rare but devastating injury complex involving high velocity blunt trauma to the osseous, muscular, neurologic, and vascular structures of the shoulder girdle. Often seen following a motor vehicle or motorcycle accident, this injury complex presents with vascular trauma in over 80% of cases. We present a unique case of scapulothoracic dissociation secondary to a self-inflicted shotgun wound to the shoulder, not previously reported in the literature. The patient presented in hemorrhagic shock, with an open wound to the chest, and a flaccid, pulseless left upper extremity. Imaging was consistent with subclavian artery transection with thrombosis. He underwent successful upper extremity revascularization with a hybrid approach including open wound exploration and endovascular repair of the subclavian artery. Furthermore, we review the diagnosis and treatment of scapulothoracic dissociation and discuss the safety of emerging hybrid vascular techniques in the management of subclavian and axillary vessel trauma.
肩胛胸壁分离是一种罕见但极具破坏性的损伤复合体，涉及对肩胛带的骨骼、肌肉、神经和血管结构的高速钝性创伤。这种损伤复合体常见于机动车或摩托车事故后，超过80%的病例伴有血管创伤。我们报告了一例独特的肩胛胸壁分离病例，继发于肩部自伤霰弹枪伤，此前文献中未见报道。患者出现失血性休克，胸部有开放性伤口，左上肢松弛、无脉。影像学检查结果与锁骨下动脉横断伴血栓形成相符。他通过包括开放性伤口探查和锁骨下动脉血管腔内修复的混合方法成功实现了上肢血管重建。此外，我们回顾了肩胛胸壁分离的诊断和治疗，并讨论了新兴混合血管技术在锁骨下和腋血管创伤管理中的安全性。
