TITLE:
Axillary Vessels and Brachial Plexus Traumas in Abidjan: Lesional Aspects and Surgical Difficulties
AUTHORS:
Yoboua Aimé Kirioua-Kamenan, Assoumou Lucien Asseke, Jean Calaire Degré, Koutoua Eric Katché, Ibrahim Junior Yeo, Marc Hervé Kassi, Zolé Cedrick Doh, Kwadjau Anderson Amani, Kouassi Antonin Souaga, Kouassi Flavien Kendja
KEYWORDS:
Brachial Plexus Surgery, Distal Paralysis of the Thoracic Limb, False Aneurysms, Flattening-Prosthetic Graft, Traumatic Axillary Lesions
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.5,
May
26,
2023
ABSTRACT: Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and
surgical aspects, we report our experience in the management of traumatic
axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical
records of patients who suffered vascular axillary and/or brachial plexus
trauma and who underwent surgical repair at the Abidjan Cardiology Institute
from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data
were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on
average, were collected. The circumstances of occurrence were dominated by the
stab wound (n = 22). The
combinations of injuries were as follows: associated involvement of the
axillary artery and vein (n = 4); isolated involvement of axillary artery (n = 3); isolated involvement of the axillary vein (n = 2); associated involvement of
the axillary artery and brachial plexus (n = 17); associated involvement of the axillary artery and
vein and brachial plexus (n = 08). Anatomic lesions included acute arterial
lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4).
All patients were operated on under
general anesthesia; vascular repair included direct suturing (n = 16), arterial
and venous bypass using a long saphenous graft (n = 9), prosthetic arterial
bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end
anastomosis of each transected bundle in all cases (n = 25). The medium-term
postoperative course was marked by success without functional sequelae in 88.24%
of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb
after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions
has given good results. However, if paralysis of the thoracic limb persists
after 6 to 12 months, the patient should be referred to a specialist in
brachial plexus surgery.