title: Complete avulsion of brachial plexus with associated vascular trauma: feasibility of reconstruction using the double free muscle technique.
abstract: BACKGROUND
  Vascular trauma associated with brachial plexus injury affects the selection of reconstructive procedures. Often, there is a paucity of appropriate recipient vessels with adequate blood flow for functioning free muscle transfer. The presence of associated vascular injuries of the subclavian or axillary artery is considered a contraindication to the double free muscle technique. The authors hypothesized that vascular repair of subclavian or axillary artery trauma might not be necessary for successful reconstruction using the double free muscle technique, provided that the recipient arteries for functioning free muscle transfer (e.g., thoracoacromial and thoracodorsal arteries) are found to be patent on preoperative angiography.
  
  
  METHODS
  The authors investigated the pathway of collateral circulation and potential recipient vessels for functioning free muscle transfer reconstruction in 20 brachial plexus injury patients associated with subclavian or axillary artery trauma using multidetector-row computed tomographic angiography. Based on these findings, the authors restored upper extremity function using the double free muscle technique without surgical repair of the injury to the major vessel in three patients.
  
  
  RESULTS
  The suprascapular artery was the major stem artery for collateral circulation, and the circumflex scapular and subscapular arteries were major reentry arteries. The authors successfully used the thoracoacromial and thoracodorsal arteries as the recipient vessels for functioning free muscle transfers in the double free muscle technique. The preliminary functional outcomes of all three cases were satisfactory.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of double free muscle technique reconstruction in brachial plexus injury patients, without actual vascular repair for the associated subclavian or axillary artery trauma.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Ogori, Yamaguchi, Japan From the Department of Orthopedic Surgery, Ogori Daiichi General Hospital.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Hattori
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Doi
authors.forename: Sotetsu
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Nilesh G
authors.initials: NG
authors.lastname: Satbhai
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D001917:Brachial Plexus / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D003097:Collateral Circulation; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult