This study describes 45 young (mean age 38.5 years) male patients with firearm injuries who presented with vascular and neurologic lesions. A synchronous one-stage neurovas cular reconstruction was undertaken in these patients; 75.5% of the traumas involved the clavioaxillary region, producing 32 regional aneurysms (71.1%), 2 major vascular lacer ations (4.4%), and a high degree of neurotmesis (48.8%) and axonotmesis (26.7%) in the brachial plexus (BP). Lower limb vascular lesions included 5 aneurysms associated with significant regional neurotmesis. The follow-up rate was poor and declined from 100% at six weeks to 70.5% at one year and 22.7% at five years. Initial vascular patency rate of 95.5% at six weeks persisted throughout in a similar manner, but the declining reatten dance rate drastically reduced statistical reliability. Recovery to grade III or better was observed in 75% of nerve grafts in the BP region, with 89% of the neurolyzed nerves showing this improvement. The results in the lower limb were comparable. The main idea of presenting this study is to show a pattern that is typical of a third-world country with lack of financial resources, a poor patient-compliance, and peer bias.
DeBakey ME, Simeone FA: Battle injuries of the arteries in World War II. An analysis of 2471 cases . Ann Surg123:534-579, 1946,
3.
Drapanas T., Hewitt RL, Weichert RF, et al: Civilian vascular injuries: A critical appraisal of three decades of management. Ann Surg172:351-360, 1970.
4.
Batey NR, Makin GS: Neurovascular traction injuries of the upper limb root. Br J Surg69:35-37, 1982.
5.
Graham JM, Feliciano DV, Matox KL, et al: Management of subclavian vascular injuries. J Trauma20:537-543, 1980.
Smith Srg: The principles underlying graft selection for arterial reconstruction. Br J Hosp Med38:358-363, 1987.
26.
Pappas G., Janes JM, Bernatz PE, et al: Femoral aneurysms. Review of surgical management. JAMA190:489-493, 1964.
27.
Schucksmith HS: Cerebral and peripheral emboli caused by cervical ribs. Br Med J2:835-837, 1963.
28.
Babar Sma, Aftab A.: Radial artery aneurysm. Med Pract1:7-10, 1989.
29.
Babar Sma: Peripheral pseudoaneurysms in a third world country. J Vasc Surg27:253-263, 1993.
30.
Babar Sma: Aneurysms of the upper limbs. Ind Pract44:949-958, 1991.
31.
Lane IF, Green IL, Greenhalgh RM: Non invasive assessment of arterial disease. Hosp Update10:861-868, 1984.
32.
Gooding GA, Effeney DJ: Ultrasound of femoral arterial aneurysm. Am J Rad134:477-480, 1980.
33.
Hartnell GG : Doppler ultrasound and digital vascular imaging . Br J Hosp Med36:433-436, 1986.
34.
Scott Rap: Ultrasound imaging in the management of abdominal aortic aneurysm. Int Angiol5:263-267, 1986.
35.
Yao Jst, Nicholaides AN: Transcutaneous Doppler ultrasound in the management of lower limb ischaemia . In: Investigations of Vascular disorders, ed. by Nicholaides AN.Yao JST.Edinburgh: Churchill-Livingstone , 1981, pp 249-273.
Leffert RA: Clinical diagnosis, testing and electromyographic study in brachial plexus traction injuries. Clin Orthop and Rel Res237:24-31, 1988.
42.
Babar Sma.Peripheral nerve injuries. Accepted for publication by Chinese Medical Journal, in 1993.
43.
Jelasic F., Piepgrasu: Functional restitution after cervical avulsion injury with typical myelographic findings. Folia Haematol (Leipz), Eng trasl101:158-163, 1974.
44.
Jones S.: Investigations of brachial plexus traction lesions by peripheral and final somoatosensory evoked potentials. J Neurol Neurosurg Psychiat42:107-116, 1979.
45.
Jones SJ, Parry CB, Landi A.: Diagnosis of brachial plexus traction lesions by sensory nerve action potentials and somatosensory evoked potentials. Injury12:376-382, 1981.
46.
Nichols JS, Lillehei KO: Nerve injury associated with acute vascular trauma. Surg Clin North Am68:837-852, 1988.
47.
Hentz VR, Narakas A.: The results of microneurosurgical reconstruction in complete brachial plexus palsy. Assessing outcome and predicting results. Orthop Clin North Am19:107-114, 1988.
