THE NEUROVASCULAR OUTCOME OF SCAPULOTHORACIC DISSOCIATION

Purpose: The purpose of this study was to define the role of acute rev ascularization in the management of scapulothoracic dissociation (SD), a rare injury of the upper extremity in which severe traction to the shoulder girdle results in combined arterial, brachial plexus, and mus culoskeletal injury. Methods: The results of a retrospective study of 11 patients with SD who were compared with 41 patients from the litera ture are presented. Results: All 11 patients were involved in high-spe ed accidents. All patients had chest wall hematoma, absent radial puls e, and complete brachial plexus palsy. All patients had subclavian or axillary occlusion shown by angiography; one patient with simultaneous brachial artery injury had limb-threatening ischemia. No patient had active bleeding from the injured artery. Six limbs were revascularized , five were not. All five non-revascularized limbs remained viable. No patient had delayed hemorrhage. No patient had significant neurologic recovery; all limbs remained insensate and functionless. Two viable a rms underwent late amputation because of neurologic dysfunction. Concl usion: The infrequent occurrence of delayed hemorrhage and limb-threat ening ischemia and the dismal functional outcome of the brachial plexu s injury suggest a conservative policy toward revascularization for th e arterial injury in SD.