Primary nerve repair in associated lesions of the axillary artery and brachial plexus

Diagnosis becomes more complex when there is an association of a brachial plexus injury with an arterial lesion. The principal clinical picture in most cases is acute ischemia that requires initial treatment in the emergency room, and the final results of nerve repair are generally poorer. Although delayed brachial plexus reconstruction is preferred by some authors, our experience leads us to the opinion that a combined repair presents several advantages. Immediately after trauma, the surgical field is free of scar tissue, and a precise evaluation of both the number and level of damaged nerves may be made. Vascular and nerve repair may be mutually agreed upon by both the vascular surgeon and microsurgeon, and simple sutures may often be used instead of grafts in early nerve repair. Even if the extent of nerve damage may sometimes be difficult to assess, the results of early, easier repairs can be observed in our series of 14 combined lesions. Our results indicate that collaboration between microsurgeons and vascular surgeons is a very important factor in providing a correct approach to these problematic patients.