PMC7700002_01
(A and C) X-ray demonstrated a posterior dislocation of the right elbow and fracture of radius and ulna. (B and D) Photographs above showed a massive musculoskeletal and neurovascular trauma with acute elbow dislocation.
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These fractures were remarkable for severe angulation and displacement (Figure 1). A timeline from the time of injury to the final surgery was listed in Figure S1.
(A) A longitudinal machine direction incision about 25cm long was made over the antecubital fossa. (B and C) Intraoperative photographs before and after the reconstruction. (D) X-ray showed the internal fixation of fractures.
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A longitudinal machine direction incision about 25cm long was made over the antecubital fossa under the general anesthesia (Figure 2A). It was also treated by reduction and internal fixation (Figure 2D). After removing all bruised segments of the injured arteries, a 25cm long single reversed bifurcated great saphenous vein graft was performed to restore arterial continuity, because of a combination of ease of access and suitability of the vessel (Figure 2B). The successful arterial reconstruction was evaluated by the return of distal pulses (Figure 2C).
Diagrammatic sketch of this operation. (A) Select suitable saphenous vein. (B) Reverse. (C) Transplant.
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We provided sketches in Figure 3.
(A and B) Intraoperative photographs showed the scar organization excise (skin soft-tissue expansion technique). (C) Nerve repair (end to side neurorrhaphy of median nerve stump with ulnar nerve). (D) Postoperative photo.
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Additional surgery was performed in the following years, including revision of fasciotomies, nerve repair (end to side neurorrhaphy of median nerve stump with ulnar nerve), tendon repair, further wound debridement, scar organization excise (skin soft-tissue expansion technique) and internal fixation removal (Figure 4).
(A-F) The photographs showed good functional results 10 years after the injury. (G) Wound healing of saphenous vein donor area.
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The movement of his right elbow was from 20 degrees of elbow extension to 100 of elbow flexion with slightly joint instability (Figure 5).
(A-C) The US Doppler result after reconstruction of the brachial, ulnar, and radial arteries via saphenous. (D-F) Left arm contrast.
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The hemodynamics of the reconstructed artery showed no signs of stenosis or aneurysm (Figure 6).