title: Less is more in the nonoperative management of complete brachial artery transection after supracondylar humeral fracture.
abstract: Supracondylar humeral fractures are the most common fracture of the elbow in children. Despite it being a familiar problem faced by surgeons, there are aspects of its management that remain controversial. Specifically, management of these fractures that result in a pink or perfused hand that remains pulseless after acceptable reduction is expectedly controversial. We present a patient with a supracondylar humeral fracture and loss of pulse. The patient was found to have complete brachial artery transection but maintained a pink and well-perfused hand. It was determined to forgo arterial reconstruction because of concerns of worsening ischemia by damage to the collateral circulation. Despite no arterial reconstruction, the patient had a successful outcome. Therefore, this report highlights that arterial reconstruction may not be required, even in cases of severe brachial artery injury.
authors.affiliation: Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Erik M
authors.initials: EM
authors.lastname: Wolfswinkel
authors.affiliation: Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: William M
authors.initials: WM
authors.lastname: Weathers
authors.affiliation: Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Siy
authors.affiliation: Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Horowitz
authors.affiliation: Division of Plastic Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX. Electronic address: larryh@bcm.edu.
authors.forename: Larry H
authors.initials: LH
authors.lastname: Hollier
mesh_terms: D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D002648:Child; D003097:Collateral Circulation; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011859:Radiography; D012039:Regional Blood Flow; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*