Saving the Upper Limb after Mutilating Trauma

Sebe IT, Lascăr I,Cortan S, Plostinariu M R, Carstea A I, Pencu DA and Hindocha S

Department of Medicine and Pharmacy, "Carol Davila" University, Romania
Department of Plastic, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, Romania
Department of Plastic, Aesthetic and Reconstructive Microsurgery, Country Clinical Emergency Hospital of Constanta, Romania
Department of Plastic Surgery and Regional Laser Center, Bedford Hospital, UK

^*Correspondance to: Sandip Hindocha 

 PDF  Full Text DOI: 10.25107/2474-1647.1885

Abstract

The full muscular biceps brachial rupture through strong trauma is a rare pathology reported in the literature, most of the publications displaying closed biceps brachii ruptures. The complexity of the trauma, per se (the IIIC humeral fracture type and the complete radial nerve section), is supplemented with Enterococus spp infection, resulting in a muscle defect of the anterior brachial compartment of approx. 10 cm. In this article we present the case of a 28-year-old, righthanded, victim of a road accident (car occupant) transferred from a regional hospital for sutured, superinfected wound, on the internal face of the right arm and forearm 4 days after right humerus osteosynthesis with external fixator for open type IIIC humeral fracture and radial nerve neuroraphy. After the admission in our clinic we have instituted antibiotic treatment adapted to the antibiogram. Over the next 20 days, a series of surgical interventions is being proposed and performed to repair the infectious outbreak and repair the resulting substance defect. To achieve these goals, we opted for a seemingly simple surgical technique, but adapted to the condition of the patient-the direct muscular suture, and immobilisation of the upper limb affected in the hyperflex of the elbow joint with the hip joint support. The chosen therapeutic attitude, the post-surgical recovery exercises and the periodic evaluation of the patient's evolution led to a functional result that enabled him to fully reintegrate the socio-professional and to a satisfying aesthetic result, but with the possibility of improvement. The complete rupture of muscular brachial biceps is a rare pathology. In our clinic, a reference center for severe cases of trauma in Romania, registering a number of 4 cases in the last 5 years, all of which are closed trauma, excepting the one presented. Soft tissues infections are a common complication when complex trauma occurs, especially if associated with open fractures. The likelihood of the infection spreading in depth depends on the type of trauma, localization, soft tissue thickness, patient co-morbidity, and treatment prior to immobilization. The radial nerve is the most commonly injured nerve in the arm, due to its localization in the proximity of the bone structure, being frequently affected in the case of humerus fractures, especially of the transversal and spiroids of the middle-distal third of the arm. Covering the substance deffect is a challenge of plastic surgery. It may be necessary to use the pediculated or freely transfered flaps, if the straight, tension free suture of the biceps' own muscle heads can not be achieved. Depending on the patient's option, scar tissue excisions or tissue expansion may be practiced to improve aesthetic appearance with continued medical recovery to increase the mass and muscle strength of the affected upper limb.

Keywords

Complete rupture body biceps brachial; Nosocomial infection; Recovery; Radial nerve; Enteroccocus spp; Humerus fracture type IIIC; Neurorrhaphy; Rehabilitation; Limb saving; Mutilated trauma; Complex injuries of the limbs

Cite the article

Sebe IT, Lasc?r I,Cortan S, Plostinariu MR, Carstea AI, Pencu DA, et al. Saving the Upper Limb after Mutilating Trauma. Clin Surg. 2018; 3: 1885.