Median Sternotomy for the Management of Life-Threatening Bleeding Resulting from Proximal Upper Extremity Amputation

ABSTRACT

It is extremely difficult to achieve hemostasis in the case of proximal amputation of major limbs, and especially in the case of a proximal upper arm amputation, which is adjacent to the axilla. A 30-year-old male sustained a traumatic proximal left upper extremity amputation resulting in hypovolemic shock. A median sternotomy was performed to clamp the left subclavian artery. The completely transected brachial artery was reconstructed with an artificial vascular graft and the transected nerves were repaired. With simultaneous rehabilitation, the patient recovered from the hypovolemic shock and ischemic injury of the arm. Performing a median sternotomy for proximal clamping of the transected artery allowed control of the bleeding which could not be controlled by a pressure cuff. This procedure may be considered a safe and effective surgical option for patients with traumatic proximal upper extremity amputation.