Structural and Functional Salvaging of Traumatic Brachial Artery Cut with Multiple Nerve Cut: Case Series

Abstract

Upper limb arterial injury is relatively rare among trauma cases. Among them, the majority is contributed by brachial artery injury. Brachial artery injury is associated with nerve injuries given that its anatomical course, which brings a significant impact to the patient. We reported 2 cases of patients who sustained a deep laceration wound over the right upper limb. Both presented to the Emergency department with active bleeding over the wound, and clinically cold right hand, associated with absent radial and ulnar pulses with profound sensory and motor deficit. Wound exploration and brachial artery repair with reverse saphenous vein interposition graft, followed by structural and nerve repair. This case series highlighted the importance of prompt detection and intervention of brachial artery injury. Any further delay might result missing the golden hour of revascularization for the patients. It also showed the importance of consideration of limb salvage in a patient who was deemed Rutherford III, especially nerve cut was uncertain. In conclusion, prompt intervention of traumatic brachial artery injury and proper intraoperative assessment are mandatory to properly decide if a limb is salvageable or not.