Upper limb vascular traumas with vascular exposure: Difficulties of reconstruction in an isolated cardiovascular surgical environment

Abstract

Introduction and Objective: Advocate for the knowledge and development of intrahospital therapeutic management of vascular trauma with vascular exposure, in our working conditions. Materials and Methods: This was a descriptive retrospective study which covered the period from January 2015 to June 2022. It was carried out from the medical records of patients operated on for vascular trauma with exposure of the vessels, in the Cardiovascular Surgery Department at the Abidjan Heart Institute. The following data were studied: epidemiological data, anatomo-clinical characteristics, and therapeutic data. Results: Nine medical records of eight male and one female patient were collected. The average age of the patients was 36 years. Elementary vascular lesions were as follows: complete section of the brachial artery and vein (n = 3), loss of substance of the brachial artery (n = 2), contusion of the brachial artery (n = 1), lateral wound of the ulnar artery (n = 2), and complete section of the radial artery (n = 1). Revascularization consisted in a brachio-brachial arterial bypass using a great saphenous vein graft (n = 3), end-to-end, respectively, arterial and venous anastomosis (n = 3), direct suture of the ulnar artery (n = 2), and in a radio-radial end-to-end arterial anastomosis (n = 1). The covering flaps used were the biceps brachii brachial muscle pedicled flap (n = 6) and the pedicled fasciocutaneous inguinal flap of McGregor (n = 3). The immediate and short-term postoperative follow-up was simple in all patients with scars of good trophicity. Conclusion: The surgical treatment requires skills in plastic surgery for the cardiovascular surgeon or the joint participation, in an emergency, of the cardiovascular surgeon and the plastic surgeon or, if necessary, the management of the patient in two stages. This last therapeutic modality generates additional morbidities and financial cost for the patient.

Keywords

• biceps brachial muscle pedicled flap
• pedicled fasciocutaneous inguinal flap of mcgregor
• vascular exposure
• vascular trauma