A Case of Brachial Plexus Injury Due to Physical Restraint

The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. It begins with the anterior rami of C5, C6, C7, C8, and the first thoracic nerve. It terminates with the formation of the musculocutaneous, median, ulnar, axillary, and radial nerves. The anatomy of the brachial plexus can be confusing, especially because of frequent variations in the length and the caliber of each of its components. The most common type of injury is one involving a motorcycle or bicycle crash in which a forceful impact on the shoulder depresses the entire shoulder girdle and avules a portion of the plexus. The injuried area is usually the upper trunk althrough the lower trunk can be involved either in addition to or as the main site of injury. Our case involves brachial plexus injury due to physical restraint that had been used to avoid using a pharmachologic restraint.

Evaluation of the Effect Factor on Replantation and Revascularization of an Amputated Digit

PURPOSE: To find the factors influencing the immediate and late outcome of replantation and revascularization of the digits, we carried out a prospective study from 1998 to 1999 with at least a 1-year followup. Traumatic total and subtotal amputations with inadequate circulation of the digits distal to the metacarpal head were included in the study. METHODS: This study was carried out as a prospective study from 1998 to 1999 with at least a 1- year followup. The relationship between age, sex, extent of injury, type of injury, ischemic time, regular smoking, level of injury, and survival rate were analyzed. There were 234 patients with 155 males (254 digits) and 79 females (129 digits). RESULTS: Successful operation was found in 203 patients (86.3%), 314 digits (82%). Although male patients seemed to have poorer survival rates than female, it should be noted that male patients had more severe injuries than female patients. All patients who were regular cigarette smokers were males. Cigarette smoking has been shown to cause cutaneous vasoconstriction, decrease the digital blood flow, and impair the wound healing. These two reasons might explain the lower survival rate in males than in females. Type of injury significantly affected the survival rate. The survival rate was very low in extensive crushed amputation (11.1% survival rate), followed by degloving (21.1% survival rate) and avulsion (64.7% survival rate) amputation. The level of injury also seemed to determine the survival rate as injury at Zone I (65% survival rate) resulted in a poor survival rate compared to the injury at Zone II, III, or IV (92%, 97.6%, or 90.9% survival rate). Ischemic time longer than 8 hours might lessen the survival rate. CONCLUSION: All patients who had successful replantation and revascularization were satisfied with the results even though they had rather poor hand movement. In single digital replantation, no patients needed reamputation, but all preferred to have their finger replanted than udergo a primary amputation. All could accommodate and adapt their injured digits to their work.