[The avulsion of subclavian artery from brachiocephalic trunk and subclavian vein from right brachiocephalic vein with brachial plexus injury].
The detachment of subclavian artery from brachiocephalic trunk and subclavian vein from right brachiocephalic vein with brachial plexus injury.


BACKGROUND
Traumas of large vessels of mediastinal and shoulder girdle cause significant life risk and constitute serious diagnostic and therapeutic problems because of lack of time for accurate treatment planning. Particularly difficult to treat are blunt trauma of large arteries in patients under the influence of drugs or with a progressive hypovolemic shock.


OBJECTIVE
The aim of this dissertation is presenting my own experience in treating a seventeen-year-old motorcyclist who was under the influence of alcohol suffered a detachment of subclavian artery and subclavian vein from mediastinal large vessels following a traffic accident.


METHODS
Seventeen-year-old motorcyclist who was under the influence of alcohol alcohol hit a concrete pole at a speed of 130 km/h. The patient was brought to the hospital in a state of hypovolemic shock, pulse 126/min, blood pressure 80/60 mmHg, without pulse on the right upper limb. The right upper limb was cold, without active movements, pressure and pain sense. The right shoulder was tumid. The right lung without audible murmurs. Pulses on carotid arteries were perceptible. The thoracic plain film x-ray showed a shading on right half of thorax, widening of the upper mediastinum, fracture of right clavicle and the rear right shoulder sprain. Passive movements in the right elbow were correct. The patient was taken to the operating theatre because of progressive hypovolemic shock and was operated in emergency regimen. The transverse thoracotomy was made by both the intercostals spaces between the second and third rib. The thoracotomy showed that subclavian artery from brachiocephalic trunk and subclavian vein from right brachiocephalic vein were detachment. The subclavian vein was ligated and the brachiocephalic vein was sewn (phleborrhaphy). The subclavian artery was connected with brachiocephalic trunk by a synthetic vascular graft so that the received pulse at the periphery of the upper limb. The thyrocervical trunk, costocervical trunk and damaged intercostal vessels at the first, second and third rib were also ligated. The sprained shoulder was set. During the operation, there was no sight that even one of fascicles of brachial plexus was interrupted. The next day pateint was reoperated because of hemorrhage to right pleura. The rest of intercostal vessels at the first, second and third rib were ligated.


RESULTS
The postoperative course was uneventful surgery. After operation was found that ulnar and radial nerve were demaged. The right lung expansion was achieved, upper limb had pulse, wounds healed as needed. The patient was transferred to the neurosurgical treatment.


CONCLUSIONS
The quick decision to conduct operations without accurate diagnosis was the only factor for patient survival.
Wojewódzki Szpital Zespolony im. L. Perzyny w Kaliszu, Oddział Chirurgii Ogólnej i Naczyń. jarekkasperczak@gmail.com
Jarosław
J
Kasperczak
D000293:Adolescent; D000435:Alcoholic Intoxication / Q000150:complications; D001642:Bicycling / Q000293:injuries; D001917:Brachial Plexus / Q000293:injuries*; D016122:Brachiocephalic Trunk / Q000293:injuries*; D016121:Brachiocephalic Veins / Q000293:injuries*; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008026:Ligation; D008297:Male; D009049:Motorcycles; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011859:Radiography; D012769:Shock / Q000209:etiology; D000070599:Shoulder Injuries; D013180:Sprains and Strains / Q000628:therapy; D013348:Subclavian Artery / Q000293:injuries*; D013350:Subclavian Vein / Q000293:injuries*; D013908:Thoracotomy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis / Q000601:surgery*