Crush injury right arm-reconstruction of blood vessels, nerves, bone to save the limb

A Young male patient met with an accident (side swap injury) with the crushed right arm, loss of mid-segment of humerus, 6 cm segment loss of brachial vein, crushed brachial artery, segment loss of median and radial nerves. crushed and devitalized muscles of the arm. Cold forearm and hand with absent pulsations and spo2 in fingers.
reached hospital 5 hours after the accident. Revascularized 9 hours after the accident.

Brachial artery and vein reconstructed with 6cm long interposition vein grafts. Radial artery repaired after thrombectomy. Nailing done for both bone forearm.

Median and radial nerves reconstructed with cables of sural nerve grafts. Humerus reconstructed with osteocutaneos free vascularized fibula flap. Fibula stabilized with plates and flap artery (peroneal) anastomosed end to side to brachial artery and vein to branch of brachial vein.
Distally based fasciocutaneous flap transposed from cubital fossa to cover distal part of plate and radial nerve.

After 40 days

In conclusion, debridement, reconstruction of brachial artery and vein with vein graft, radial artery repair, reconstruction of median and radial nerves with sural nerve grafts, reconstruction of humerus with vascularized fibula flap and fasciocutaneos flap to cover distal part of plate/humerus done to save the limb.

#microvascularsurgery #freevascularizedflaps #limbsavingsurgery #BisoniyaHospital #DrHariSinghBisoniya