Skip to main content
Top
Published in: Neurosurgical Review 2/2017

01-04-2017 | Original Article

Nerve injuries of the upper extremity associated with vascular trauma—surgical treatment and outcome

Authors: Lukas Rasulic, Ilijas Cinara, Miroslav Samardzic, Andrija Savic, Bojana Zivkovic, Filip Vitosevic, Mirko Micovic, Vladimir Bascarevic, Vladimir Puzovic, Stefan Mandic-Rajcevic

Published in: Neurosurgical Review | Issue 2/2017

Login to get access

Abstract

Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is a high chance of combined injuries of these structures (23 %). The aim of our study is to describe and analyze associated nerve and vascular injuries of the upper extremity in patients treated at the Clinic of Neurosurgery in Belgrade over a 10-year period. This study included 83 patients that received surgical treatment at the Clinic of Neurosurgery in Belgrade after having been diagnosed with upper extremity nerve injury. The study included all patients that satisfied these criteria over a period of 10 years. The patients with associated vascular injuries, 36 of them, were considered our study group, while 47 patients without associated vascular injuries were considered our control group. Finally, we compared treatment outcome between these groups. The final outcome evaluation was performed 2 years after surgical treatment. In our study group, 84.8 % surgical nerve repair was successful (fair, good, and excellent outcome), while in the control group (patients without vascular injury), surgical nerve repair was successful in 87.9 %. The overall satisfactory neurological outcome (M3–M5) was present in 86.6 % of nerve repairs. Our study shows that there is no significant difference between the treatment outcome in patients with associated nerve and vascular injuries and patients with isolated nerve injuries if they are diagnosed in time and treated appropriately. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team.
Literature
1.
go back to reference Balakrishnan G (2006) Ischaemic contracture of the hand. Indian J Plast Surg 39:94–102CrossRef Balakrishnan G (2006) Ischaemic contracture of the hand. Indian J Plast Surg 39:94–102CrossRef
2.
go back to reference Barmparas G, Inaba K, Talving P, David JS, Lam L, Plurad D, Green D, Demetriades D (2010) Pediatric vs adult vascular trauma: a National Trauma Databank review. J Pediatr Surg 45:1404–1412CrossRefPubMed Barmparas G, Inaba K, Talving P, David JS, Lam L, Plurad D, Green D, Demetriades D (2010) Pediatric vs adult vascular trauma: a National Trauma Databank review. J Pediatr Surg 45:1404–1412CrossRefPubMed
3.
go back to reference Birch R, Raji AR (1991) Repair of median and ulnar nerves. Primary suture is best. J Bone Joint Surg (Br) 73(1):154–157 Birch R, Raji AR (1991) Repair of median and ulnar nerves. Primary suture is best. J Bone Joint Surg (Br) 73(1):154–157
4.
go back to reference Chung KC, Spilson SV (2001) The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg [Am] 26:908–915CrossRef Chung KC, Spilson SV (2001) The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg [Am] 26:908–915CrossRef
5.
6.
go back to reference Dougherty AL, Mohrle CR, Galarneau MR, Woodruff SI, Dye JL, Quinn KH (2009) Battlefield extremity injuries in operation Iraqi Freedom. Injury 40:772–777CrossRefPubMed Dougherty AL, Mohrle CR, Galarneau MR, Woodruff SI, Dye JL, Quinn KH (2009) Battlefield extremity injuries in operation Iraqi Freedom. Injury 40:772–777CrossRefPubMed
7.
go back to reference Eser E, Aktekin LA, Bodur H, Atan C (2009) Etiological factors of traumatic peripheral nerve injuries. Neurol India 57(4):434–437CrossRefPubMed Eser E, Aktekin LA, Bodur H, Atan C (2009) Etiological factors of traumatic peripheral nerve injuries. Neurol India 57(4):434–437CrossRefPubMed
8.
go back to reference Eser F, Aktekin LA, Bodur H, Atan C (2009) Etiological factors of traumatic peripheral nerve injuries. Neurol India 57:434–437CrossRefPubMed Eser F, Aktekin LA, Bodur H, Atan C (2009) Etiological factors of traumatic peripheral nerve injuries. Neurol India 57:434–437CrossRefPubMed
9.
go back to reference Fakhrai M, Elshimali Y (2007) Repair of the first segment of subclavian artery injury in a trauma patient without thoracotomy. The Internet Journal of Thoracic and Cardiovascular Surgery 12:2 Fakhrai M, Elshimali Y (2007) Repair of the first segment of subclavian artery injury in a trauma patient without thoracotomy. The Internet Journal of Thoracic and Cardiovascular Surgery 12:2
10.
go back to reference Franz RW, Skytta CK, Shah KJ, Hartman JF, Wright ML (2012) A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg 26:655–664CrossRefPubMed Franz RW, Skytta CK, Shah KJ, Hartman JF, Wright ML (2012) A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg 26:655–664CrossRefPubMed
11.
go back to reference Galanakos SP, Zoubos AB, Ignatiadis I, Papakostas I, Gerostathopoulos NE, Soucacos PN (2011) Repair of complete nerve lacerations at the forearm: an outcome study using Rosén–Lundborg protocol. Microsurg 4:253–262CrossRef Galanakos SP, Zoubos AB, Ignatiadis I, Papakostas I, Gerostathopoulos NE, Soucacos PN (2011) Repair of complete nerve lacerations at the forearm: an outcome study using Rosén–Lundborg protocol. Microsurg 4:253–262CrossRef
12.
go back to reference Gümbel D, Naundorf M, Napp M, Ekkernkamp A, Seifert J (2014) Diagnosis and management of peripheral vascular injuries. Unfallchirurg 117:445–460CrossRefPubMed Gümbel D, Naundorf M, Napp M, Ekkernkamp A, Seifert J (2014) Diagnosis and management of peripheral vascular injuries. Unfallchirurg 117:445–460CrossRefPubMed
13.
go back to reference Iriz E, Kolbakir F, Sarac A, Akar H, Keçeligil HT, Demirağ MK (2004) Retrospective assessment of vascular injuries: 23 years of experience. Ann Thorac Cardiovasc Surg 10:373–378PubMed Iriz E, Kolbakir F, Sarac A, Akar H, Keçeligil HT, Demirağ MK (2004) Retrospective assessment of vascular injuries: 23 years of experience. Ann Thorac Cardiovasc Surg 10:373–378PubMed
14.
go back to reference Jain DK, Bhardwaj P, Venkataramani H, Sabapathy SR (2012) An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre. Indian J Plast Surg 45(3):498–503CrossRefPubMedPubMedCentral Jain DK, Bhardwaj P, Venkataramani H, Sabapathy SR (2012) An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre. Indian J Plast Surg 45(3):498–503CrossRefPubMedPubMedCentral
15.
go back to reference Kallio PK, Vastamaki M (1993) An analysis of the results of late reconstruction of 132 median nerves. J Hand Surg 188:97–105CrossRef Kallio PK, Vastamaki M (1993) An analysis of the results of late reconstruction of 132 median nerves. J Hand Surg 188:97–105CrossRef
16.
go back to reference Kim DH, Murovic JA, Tiel RL, Kline DG (2004) Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus 16(5):E2PubMed Kim DH, Murovic JA, Tiel RL, Kline DG (2004) Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus 16(5):E2PubMed
17.
go back to reference Kouyoumdjian JA (2006) Peripheral nerve injuries: a retrospective survey of 456 cases. Muscle Nerve 34:785–788CrossRefPubMed Kouyoumdjian JA (2006) Peripheral nerve injuries: a retrospective survey of 456 cases. Muscle Nerve 34:785–788CrossRefPubMed
18.
go back to reference Leclercq DC, Carlier AJ, Khuc T, Depierreux L, Lejeune GN (1985) Improvement in the results in sixty-four ulnar nerve sections associated with arterial repair. J Hand Surg [Am] 10:997–999CrossRef Leclercq DC, Carlier AJ, Khuc T, Depierreux L, Lejeune GN (1985) Improvement in the results in sixty-four ulnar nerve sections associated with arterial repair. J Hand Surg [Am] 10:997–999CrossRef
19.
go back to reference Manord J, Gerrard L, Kline D, Sternbergh C, Money S (1998) Management of severe proximal vascular and neural injury of the upper extremity. J Vasc Surg 27:43–9CrossRefPubMed Manord J, Gerrard L, Kline D, Sternbergh C, Money S (1998) Management of severe proximal vascular and neural injury of the upper extremity. J Vasc Surg 27:43–9CrossRefPubMed
20.
go back to reference McAllister RM, Gilbert SE, Calder JS, Smith PJ (1996) The epidemiology and management of upper limb peripheral nerve injuries in modern practice. J Hand Surg (Br) 21(1):4–13CrossRef McAllister RM, Gilbert SE, Calder JS, Smith PJ (1996) The epidemiology and management of upper limb peripheral nerve injuries in modern practice. J Hand Surg (Br) 21(1):4–13CrossRef
21.
go back to reference Millesi H (2006) Factors affecting the outcome of peripheral nerve surgery. Microsurgery 26(4):295–302CrossRefPubMed Millesi H (2006) Factors affecting the outcome of peripheral nerve surgery. Microsurgery 26(4):295–302CrossRefPubMed
22.
go back to reference Novak CB, Anastakis DJ, Beaton DE, Katz J (2009) Patient-reported outcome after peripheral nerve injury. J Hand Surg [Am] 34:281–287CrossRef Novak CB, Anastakis DJ, Beaton DE, Katz J (2009) Patient-reported outcome after peripheral nerve injury. J Hand Surg [Am] 34:281–287CrossRef
23.
go back to reference Puzovic V, Samardzic M, Jovanovic M, Zivkovic B, Savic A, Rasulic L (2015) Etiology and mechanisms of ulnar and median forearm nerve injuries. Vojnosanit Pregl 72(11):961–7CrossRefPubMed Puzovic V, Samardzic M, Jovanovic M, Zivkovic B, Savic A, Rasulic L (2015) Etiology and mechanisms of ulnar and median forearm nerve injuries. Vojnosanit Pregl 72(11):961–7CrossRefPubMed
24.
go back to reference Rasulic L, Puzović V, Krešimir R, Jovanović M, Samardžić M, Živković B, Savić A (2015) The epidemiology of forearm nerve injuries—a retrospective study. Acta Clin Croat 54(1):19–24PubMed Rasulic L, Puzović V, Krešimir R, Jovanović M, Samardžić M, Živković B, Savić A (2015) The epidemiology of forearm nerve injuries—a retrospective study. Acta Clin Croat 54(1):19–24PubMed
25.
go back to reference Rasulic L, Samardzic M (2015) Nerve grafting methods. In: Tubbs S (ed) Nerves and nerve injuries: vol 2: pain, treatment, injury, disease and future directions. Academic Press, San Diego, p 237–248 Rasulic L, Samardzic M (2015) Nerve grafting methods. In: Tubbs S (ed) Nerves and nerve injuries: vol 2: pain, treatment, injury, disease and future directions. Academic Press, San Diego, p 237–248
26.
go back to reference Razmadze A (1999) Vascular injuries of the limbs: a fifteen-year Georgian experience. Eur J VascEndovascSurg 18:235–239 Razmadze A (1999) Vascular injuries of the limbs: a fifteen-year Georgian experience. Eur J VascEndovascSurg 18:235–239
27.
go back to reference Saadat S, Eslami V, Rahimi-Movaghar V (2011) The incidence of peripheral nerve injury in trauma patients in Iran. UlusTravmaAcilCerrahiDerg 17:539–44 Saadat S, Eslami V, Rahimi-Movaghar V (2011) The incidence of peripheral nerve injury in trauma patients in Iran. UlusTravmaAcilCerrahiDerg 17:539–44
28.
go back to reference Samardzic M, Rasulic L, Grujicic D, Milicic B (2000) Results of nerve transfer to the musculocutaneous and axillary nerves. Neurosurgery 46:93–103CrossRefPubMed Samardzic M, Rasulic L, Grujicic D, Milicic B (2000) Results of nerve transfer to the musculocutaneous and axillary nerves. Neurosurgery 46:93–103CrossRefPubMed
29.
go back to reference Secer HI, Daneyemez M, Gonul E, Izci Y (2007) Surgical repair of ulnar nerve lesions caused by gunshot and shrapnel: results in 407 lesions. J Neurosurg 107:776–783PubMed Secer HI, Daneyemez M, Gonul E, Izci Y (2007) Surgical repair of ulnar nerve lesions caused by gunshot and shrapnel: results in 407 lesions. J Neurosurg 107:776–783PubMed
30.
go back to reference Shaw AD, Milne AA, Christie J, Jenkins AM, Murie JA, Ruckley CV (1995) Vascular trauma of the upper limb and associated nerve injuries. Injury 26:515–518CrossRefPubMed Shaw AD, Milne AA, Christie J, Jenkins AM, Murie JA, Ruckley CV (1995) Vascular trauma of the upper limb and associated nerve injuries. Injury 26:515–518CrossRefPubMed
31.
go back to reference Shi L (2013) The delayed management of main arterial injuries in extremity trauma: surgical challenges and outcomes. Pak J Med Sci 29:64–67PubMedPubMedCentral Shi L (2013) The delayed management of main arterial injuries in extremity trauma: surgical challenges and outcomes. Pak J Med Sci 29:64–67PubMedPubMedCentral
32.
go back to reference Siqueira MG, Martins RS (2011) Surgical treatment of adult traumatic brachial plexus injuries: an overview. Arq Neuropsiquiatr 69(3):528–535CrossRefPubMed Siqueira MG, Martins RS (2011) Surgical treatment of adult traumatic brachial plexus injuries: an overview. Arq Neuropsiquiatr 69(3):528–535CrossRefPubMed
33.
go back to reference Stanec S, Tonković I, Stanec Z, Tonković D, Dzepina I (1997) Treatment of upper limb nerve war injuries associated with vascular trauma. Injury 28:463–468CrossRefPubMed Stanec S, Tonković I, Stanec Z, Tonković D, Dzepina I (1997) Treatment of upper limb nerve war injuries associated with vascular trauma. Injury 28:463–468CrossRefPubMed
34.
go back to reference Tan TW, Joglar FL, Hamburg NM, Eberhardt RT, Shaw PM, Rybin D, Doros G, Farber A (2011) Limb outcome and mortality in lower and upper extremity arterial injury: a comparison using the National Trauma Data Bank. Vasc Endovascular Surg 45:592–597CrossRefPubMed Tan TW, Joglar FL, Hamburg NM, Eberhardt RT, Shaw PM, Rybin D, Doros G, Farber A (2011) Limb outcome and mortality in lower and upper extremity arterial injury: a comparison using the National Trauma Data Bank. Vasc Endovascular Surg 45:592–597CrossRefPubMed
35.
go back to reference Topal AE, Eren MN, Celik Y (2010) Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management. Vasc Health Risk Manag 6:1103–1110CrossRefPubMedPubMedCentral Topal AE, Eren MN, Celik Y (2010) Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management. Vasc Health Risk Manag 6:1103–1110CrossRefPubMedPubMedCentral
36.
go back to reference Troupis TG, Michalinos A, Manou V, Vlastos D, Johnson EO, Demesticha T, Skandalakis P (2014) Report of an unusual combination of arterial, venous and neural variations in a cadaveric upper limb. J Brachial Plex Peripher Nerve Inj 9:2CrossRefPubMedPubMedCentral Troupis TG, Michalinos A, Manou V, Vlastos D, Johnson EO, Demesticha T, Skandalakis P (2014) Report of an unusual combination of arterial, venous and neural variations in a cadaveric upper limb. J Brachial Plex Peripher Nerve Inj 9:2CrossRefPubMedPubMedCentral
37.
go back to reference Vastamäki M, Kallio PK, Solonen KA (1993) The results of secondary microsurgical repair of ulnar nerve injury. J Hand Surg 18:323–326CrossRef Vastamäki M, Kallio PK, Solonen KA (1993) The results of secondary microsurgical repair of ulnar nerve injury. J Hand Surg 18:323–326CrossRef
Metadata
Title
Nerve injuries of the upper extremity associated with vascular trauma—surgical treatment and outcome
Authors
Lukas Rasulic
Ilijas Cinara
Miroslav Samardzic
Andrija Savic
Bojana Zivkovic
Filip Vitosevic
Mirko Micovic
Vladimir Bascarevic
Vladimir Puzovic
Stefan Mandic-Rajcevic
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Neurosurgical Review / Issue 2/2017
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-016-0755-2

Other articles of this Issue 2/2017

Neurosurgical Review 2/2017 Go to the issue