Clements Jamie, Lewis Harry, McBride Michael
Plastic Surgery, Ulster Hospital, Belfast, GBR.
Plastic and Reconstructive Surgery, Ulster Hospital, Belfast, GBR.
Cureus. 2022 Sep 30;14(9):e29777. doi: 10.7759/cureus.29777. eCollection 2022 Sep.
Neonatal limb ischaemia is a rare disease entity with devastating morbidity, including compartment syndrome, tissue loss, limb loss, reduced limb growth, irreparable neuropathies and Volkmann's syndrome. We report a case of limb revascularisation and salvage due to intrauterine brachial artery thrombosis. Published literature is limited to case reports and case series, with various treatment modalities discussed. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of life-long morbidity. A male baby at (36+6week) gestation was born to a nulliparous mother with gestational diabetes via uncomplicated elective caesarean section. Aetiology was due to dense fibrotic circumferential constriction of the brachial vessels and plexus. Successful revascularization was achieved with a contralateral interposition reversed great saphenous vein graft. Though extremely rare and the clinical presentation varies with the location and timing after birth, the surgeon should maintain a low threshold for suspicion of in the presence of the characteristic sequelae of ischaemia. Doppler ultrasonography can aid the diagnosis where ambiguous, and therapy should be individualised based on the clinical presentation; this case emphasises the role of surgery in limb salvage.
新生儿肢体缺血是一种罕见的疾病实体，具有毁灭性的发病率，包括骨筋膜室综合征、组织缺失、肢体缺失、肢体生长受限、不可修复的神经病变和Volkmann综合征。我们报告一例因子宫内肱动脉血栓形成导致肢体血管再通和挽救的病例。已发表的文献仅限于病例报告和病例系列，并讨论了各种治疗方式。早期识别、及时采取适当的治疗和监测对于成功实现血管再通和预防终身发病至关重要。一名孕（36 + 6周）的男婴由一位患有妊娠期糖尿病的初产妇经无并发症的择期剖宫产分娩。病因是肱血管和神经丛致密的纤维化环状狭窄。通过对侧转位大隐静脉移植成功实现了血管再通。尽管极为罕见且临床表现因出生后的位置和时间而异，但外科医生在出现缺血特征性后遗症时应保持较低的怀疑阈值。在诊断不明确时，多普勒超声检查可辅助诊断，治疗应根据临床表现个体化；本病例强调了手术在肢体挽救中的作用。
