The neurovascular outcome of scapulothoracic dissociation.
OBJECTIVE
The purpose of this study was to define the role of acute revascularization in the management of scapulothoracic dissociation (SD), a rare injury of the upper extremity in which severe traction to the shoulder girdle results in combined arterial, brachial plexus, and musculoskeletal injury.


METHODS
The results of a retrospective study of 11 patients with SD who were compared with 41 patients from the literature are presented.


RESULTS
All 11 patients were involved in high-speed accidents. All patients had chest wall hematoma, absent radial pulse, and complete brachial plexus palsy. All patients had subclavian or axillary occlusion shown by angiography; one patient with simultaneous brachial artery injury had limb-threatening ischemia. No patient had active bleeding from the injured artery. Six limbs were revascularized, five were not. All five non-revascularized limbs remained viable. No patient had delayed hemorrhage. No patient had significant neurologic recovery; all limbs remained insensate and functionless. Two viable arms underwent late amputation because of neurologic dysfunction.


CONCLUSIONS
The infrequent occurrence of delayed hemorrhage and limb-threatening ischemia and the dismal functional outcome of the brachial plexus injury suggest a conservative policy toward revascularization for the arterial injury in SD.
Department of Surgery, Maine Medical Center, Portland 04102.
L N
LN
Sampson
J C
JC
Britton
J
J
Eldrup-Jorgensen
D E
DE
Clark
J M
JM
Rosenberg
C E
CE
Bredenberg
D001132:Arm / Q000098:blood supply* / Q000294:innervation; D001158:Arteries / Q000293:injuries; D001917:Brachial Plexus / Q000293:injuries*; D002968:Clavicle / Q000293:injuries; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery; D009104:Multiple Trauma / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012540:Scapula / Q000293:injuries*; D000070599:Shoulder Injuries; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome