Hybrid approach to complex vascular injury secondary to blast induced scapulothoracic dissociation

Abstract

Scapulothoracic dissociation is a rare but devastating injury complex involving high velocity blunt trauma to the osseous, muscular, neurologic, and vascular structures of the shoulder girdle. Often seen following a motor vehicle or motorcycle accident, this injury complex presents with vascular trauma in over 80% of cases. We present a unique case of scapulothoracic dissociation secondary to a self-inflicted shotgun wound to the shoulder, not previously reported in the literature. The patient presented in hemorrhagic shock, with an open wound to the chest, and a flaccid, pulseless left upper extremity. Imaging was consistent with subclavian artery transection with thrombosis. He underwent successful upper extremity revascularization with a hybrid approach including open wound exploration and endovascular repair of the subclavian artery. Furthermore, we review the diagnosis and treatment of scapulothoracic dissociation and discuss the safety of emerging hybrid vascular techniques in the management of subclavian and axillary vessel trauma.

Open reduction internal fixation with mesh plating and suture fixation for scapulothoracic dissociation: a case report and discussion of surgical methods

“…In the last decade, evidence in the literature has supported ORIF for cases of STD ( Table I ). 1 , 10 , 12 , 13 , 15 , 17 , 19 , 23 Lal et al reported the case of a 32-year-old male who sustained a Zelle 2B STD following a motor vehicle accident. They performed ORIF with successful recovery of a nearly full ROM in the shoulder postoperatively.…”

“…Approximately 52% of patients with STD will have complete loss of motor and sensory functions in the affected extremity. 1 , 10 Since STD is rare, it is difficult to create a treatment algorithm that fully captures and appropriately weighs all possible factors. However, improved decision-making aids are needed, as clinicians have voiced concerns that singular factors, such as MESS scores, are inadequate for choosing treatment and predicting outcomes.…”

A Case Report of Scapulothoracic Dissociation and Literature Review

“…Once vascular injury was identified, surgery including autogenous vein and synthetic graft implantation or endovascular repair should be implemented [Desai 2014]. Recently, endovascular technique has been utilized in more trauma patients, due to its advantages, which could avoid surgical dissection in a traumatized area and significantly decrease the risk of injury to adjoined structures [Jordan 2019]. Research with 1143 trauma patients from 22 institutions in America revealed that endovascular therapy was highly applied among severely injured blunt trauma patients; this was associated with lower incidence of complications and better clinical prognosis [Faulconer 2018].…”