Gunshot wound with lung injury, brachial plexus, axillary and intercostal artery
Keywords:
axillary artery, hemopneumothorax, brachial plexus, saphenous vein, lung injury.Abstract
Introduction: Chest traumas with associated vascular lesions worsen the prognosis of patients due to hemorrhage. 80 % of all vascular traumas affect the extremities and 30 % are located in the upper limbs. Being able to use the patient's own tissues for repair is a viable treatment alternative, and sometimes the only possible one.Objective: To present a patient with chest trauma with vascular lesions, where the saphenous vein was used to restore the damage in the axillary artery and the tractotomy technique for massive hemothorax with lesion of the lung parenchyma.
Clinical case: 32-year-old male patient with a gunshot wound to the shoulder and right hemithorax, which caused injury to the right axillary artery and massive hemothorax. A thoracotomy with tractotomy was performed at the level of the right upper lobe and ligation of the intercostal artery; and the right axillary region was explored to repair vascular damage.
Conclusions: To treat penetrating chest trauma with bleeding lung injury, a pulmonary tractotomy and hemostasis should be performed to avoid intraparenchymal hematomas. Faced with an irreparable axillary artery injury, the saphenous vein is a viable alternative for its restoration and to achieve the vitality of the limb.
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References
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8. Wall MJ, Jr, Hirshberg A, Mattox KL. Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung. Am J Surg. 1994;168(6): 665-9. DOI: 10.1016/S0002-9610(05)80141-2
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11. Asensio JA, Ogun OA, Mazzini FN, Pérez-A J, García LM, Petrone P. Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries. Eur J Trauma Emerg Surg. 2018; 44(1): 55-61. DOI: 10.1007/s00068-017-0802-x
12. Devasahayam RJ, Fabich RA, Tighe CA, Becker TE. Rare Use of Posterolateral Thoracotomy in an Austere Environment. Medicina militar. 2019; 185(3-4): 530-1. DOI: 10.1093/milmed/usz300
13. Sersar SI, Albohiri KA, Abdelmohty H. Impacted thoracic foreign bodies after penetrating chest trauma. Asian Cardiovasc Thorac Ann. 2016; 24(8): 782-7. DOI: 10.1177/0218492316664673
2. Kang DH, Park HO, Moon SH, Jang IS, Byun JH, Kim SH. Successful Tractotomy Technique for a Penetrating Lung Injury in a Patient with One Lung. Korean J Thorac Cardiovasc Surg. 2017 [acceso: 10/03/2021]; 50(5): 399-402. Disponible en: DOI: 10.5090/kjtcs.2017.50.5.399
3. Salas F, Agüero AC. Generalidades del Traumatismo Torácico. Revista Ciencia y Salud: Integrando Conocimientos. 2020 [acceso: 06/12/2020]; 4(3):95-106. Disponible en: https://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/144/231
4. Chiarelli M, Gerosa M, Guttadauro A, Gabrielli F, Vertemati G, Cazzaniga M, Fumagalli L, et al. Urgent pulmonary lobectomy for blunt chest trauma: report of three cases without mortality . Journal of thoracic disease. 2016 [acceso: 14/03/2021]; 8(7):1825. Disponible en: https://dx.doi.org/10.21037/jtd.2016.06.10
5. Valdés O, Alvia G, González J, Jalil J, Bazurto A, Roldan N. Revascularización de arteria humeral con vena safena invertida, en traumatismo vascular por arma blanca. Revista Cubana de Medicina Militar. 2021 [acceso: 07/03/2021]; 50(1): e0210722. Disponible en: https://www.revmedmilitar.sld.cu/index.php/mil/article/view/722
6. Altoijry A, Nouh T, Alburakan A, Ibrahim M, Altuwaijri TA. Endovascular Repair of a Penetrating Axillary Artery Injury. Braz J Cardiovasc Surg. 2019; 34(2):226-8. DOI: 10.21470/1678-9741-2018-0226
7. Angus LDG, Gerber N, Munnangi S, Wallace R, Singh S, Digiacomo J. Management and Outcomes of Isolated Axillary Artery Injury: A Five-Year National Trauma Data Bank Analysis. Ann Vasc Surg. 2020 [acceso: 13/03/2021]; 65:113-123. Disponible en: https://doi.org/10.1016/j.avsg.2019.10.085
8. Wall MJ, Jr, Hirshberg A, Mattox KL. Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung. Am J Surg. 1994;168(6): 665-9. DOI: 10.1016/S0002-9610(05)80141-2
9. Asensio JA, Demetriades D, Berne JD, Velmahos G, Cornwell EE, Murray J, Gómez H, et al. Stapled pulmonary tractotomy: a rapid way to control hemorrhage in penetrating pulmonary injuries. Revista del Colegio Americano de Cirujanos. 1997;185(5): 486-7. DOI: 10.1016/S1072-7515(01)00963-2
10. Wahlgren CM, Riddez L. Penetrating Vascular Trauma of the Upper and Lower Limbs. Curr Trauma Rep. 2016 [acceso: 13/12/2020]; 2(1):11-20. Disponible en: https://doi.org/10.1007/s40719-016-0035-1
11. Asensio JA, Ogun OA, Mazzini FN, Pérez-A J, García LM, Petrone P. Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries. Eur J Trauma Emerg Surg. 2018; 44(1): 55-61. DOI: 10.1007/s00068-017-0802-x
12. Devasahayam RJ, Fabich RA, Tighe CA, Becker TE. Rare Use of Posterolateral Thoracotomy in an Austere Environment. Medicina militar. 2019; 185(3-4): 530-1. DOI: 10.1093/milmed/usz300
13. Sersar SI, Albohiri KA, Abdelmohty H. Impacted thoracic foreign bodies after penetrating chest trauma. Asian Cardiovasc Thorac Ann. 2016; 24(8): 782-7. DOI: 10.1177/0218492316664673
Published
2021-12-03
How to Cite
1.
Brito Sosa G, Iraizoz Barrios AM. Gunshot wound with lung injury, brachial plexus, axillary and intercostal artery. Rev Cubana Med Milit [Internet]. 2021 Dec. 3 [cited 2025 May 12];50(4):e02101394. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1394
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