Annotation
Resume.
Goal.
To conduct a comprehensive assessment of the clinical results of emergency surgical intervention in patients with traumatic injuries to the vascularnerve structures of the upper extremities.
Material and methods.
The analysis is based on the observation of 115 patients with injuries of the vascularnerve bundles of the upper limb of various etiologies, treated in the Department of Plastic and Reconstructive Microsurgery of the Republican Scientific Center of Cardiovascular Surgery in the period from 2010 to 2025. Among them, males predominated 73 patients (63.5%), while there were 42 women (36.5%). The age of the patients ranged from 7 to 62 years, the average value was 36.7 ± 24.3 years. The diagnostic program included a standard clinical and instrumental complex: physical examination, radiography of the affected segment of the limb, as well as ultra sound duplex scanning of the vascular bed.
Results.
Patients were divided into two groups based on the nature of the injury. The first group included 37 patients (32.2%) with isolated nerve injury. The second group consisted of 78 patients (67.8%) with combined vascular and nerve injury. In all cases, the injury was unilateral.
In the isolated nerve injury group, the location of the injury was as follows: shoulder (5 cases, 13.5%), forearm (12 cases, 32.4%), and hand (20 cases, 54.1%). In patients in the second group, traumatic changes were most often detected at the forearm level (32 cases, 41.02%), hand (27 cases, 34.6%), and finger injuries were diagnosed in 19 patients (24.4%). In the first group, primary nerve reconstruction was performed as part of a singlestage emergency intervention in 19 patients (51.4%), while surgical restoration was delayed in 18 cases (48.6%). A comparative analysis of longterm functional outcomes demonstrated the advantage of singlestage reconstruction; however, its use was limited by the extent of the defect, tissue condition, and topographic and anatomical features of the injury.
In the second group, vascular patency was restored in 64 patients (82.1%). In 14 cases (17.9%), limb salvage was not possible due to severe irreversible ischemic changes. Simultaneous reconstruction of vascular and neural structures was performed in 21 patients (26.9%). In the majority of patients—43 (55.1%)—nerve restoration was performed as a second stage after circulatory stabilization.
Conclusion.
The strategy of singlestage reconstruction of nerve structures in emergency injuries to the vascularnerve bundles of the upper limb is the most preferable in terms of functional prognosis. However, clinical and anatomical limitations do not always allow for the full implementation of this approach. Refinement of the surgical strategy and further clinical trials are aimed at improving longterm functional outcomes in this patient population.
Keywords
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