A Rare Case of Brachial Artery Aneurysm in a 9-Month-Old Infant

An otherwise healthy 9-month-old infant was treated for a true aneurysm of the proximal brachial artery. The swelling was first noted at seven months of age. An ultrasound scan showed a 2 cm × 2 cm aneurysm of the left brachial artery at the level of the mid-upper arm. Whole-body magnetic resonance angiography (MRA) confirmed this was a true aneurysm of the brachial artery; there was good distal runoff and no other aneurysms elsewhere. Vasculitis screen was negative. Surgical excision of the aneurysm and reconstruction of the brachial artery was performed with a reversed cephalic vein graft. The patient made an uneventful recovery and was discharged home. We present an overview of the workup report and emphasise that a multi-disciplinary team approach is imperative for assessing and managing this rare condition.

The posterior approach to the thoracodorsal vessels for microsurgical free tissue transfer

The latissimus dorsi (LD) muscle is a workhorse flap in reconstructive surgery (e.g., breast reconstruction, chest wall defects, and lower limb trauma). The thoracodorsal artery and its venae comitantes supply this muscle. Recipient vessel options for microsurgical free flap reconstruction of the posterior thorax and lower back are limited. The thoracodorsal vessels are an excellent option due to their reliable anatomy and ease of access. In circumstances when the patient is best positioned prone, the posterior approach to access the thoracodorsal vessels is advantageous. We describe the technique to identify and isolate these vessels via a posterior approach.

The Effectiveness of Different Nerve Transfers in the Restoration of Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis

PURPOSE

Restoration of elbow flexion is an important goal in the treatment of patients with traumatic brachial plexus injury. Numerous studies have described various nerve transfers for neurotization of the musculocutaneous nerve (or its motor branches); however, there is uncertainty over the effectiveness of each method. The aim of this study was to summarize the published evidence in adults with traumatic brachial plexus injury.

METHODS

Medline, Embase, medRxiv, and bioRxiv were systematically searched from inception to April 12, 2021. We included studies that reported the outcomes of nerve transfers for the restoration of elbow flexion in adults. The primary outcome was elbow flexion of grade 4 (M4) or higher on the British Medical Research Council scale. Data were pooled using random-effects meta-analyses, and heterogeneity was explored using metaregression. Confidence intervals (CIs) were generated to the 95% level.

RESULTS

We included 64 articles, which described 13 different nerve transfers. There were 1,335 adults, of whom 813 (61%) had partial and 522 (39%) had pan-plexus injuries. Overall, 75% of the patients with partial brachial plexus injuries achieved ≥M4 (CI, 69%-80%), and the choice of donor nerve was associated with clinically meaningful differences in the outcome. Of the patients with pan-plexus injuries, 45% achieved ≥M4 (CI, 31%-60%), and overall, each month delay from the time of injury to reconstruction reduced the probability of achieving ≥M4 by 7% (CI, 1%-12%).

CONCLUSIONS

The choice of donor nerve affects the chance of attaining a British Medical Research Council score of ≥4 in upper-trunk reconstruction. For patients with pan-plexus injuries, delay in neurotization may be detrimental to motor outcomes.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.