Hybrid approach to complex vascular injury secondary to blast induced scapulothoracic dissociation

• Published in: Trauma case reports 2019-10, Vol.23, p.100236-100236, Article 100236
• Main Authors: Jordan, Rebecca, Obmann, Melissa, Song, Boyoung, Nikam, Shivprasad, Mariner, David, Toy, Frederick, Lopez, Richard
• Format: Article
• Language: English
• Subjects: Blunt trauma, penetrating trauma; Scapulothoracic dissociation; Subclavian artery injury; Surgery; Vascular trauma
• ISSN: 2352-6440; 2352-6440
• DOI: 10.1016/j.tcr.2019.100236

AbstractScapulothoracic dissociation is a rare but devastating injury complex involving high velocity blunt trauma to the osseous, muscular, neurologic, and vascular structures of the shoulder girdle. Often seen following a motor vehicle or motorcycle accident, this injury complex presents with vascular trauma in over 80% of cases. We present a unique case of scapulothoracic dissociation secondary to a self-inflicted shotgun wound to the shoulder, not previously reported in the literature. The patient presented in hemorrhagic shock, with an open wound to the chest, and a flaccid, pulseless left upper extremity. Imaging was consistent with subclavian artery transection with thrombosis. He underwent successful upper extremity revascularization with a hybrid approach including open wound exploration and endovascular repair of the subclavian artery. Furthermore, we review the diagnosis and treatment of scapulothoracic dissociation and discuss the safety of emerging hybrid vascular techniques in the management of subclavian and axillary vessel trauma.