Ischemia requiring revascularization is rare in the pediatric population. It is even
less common to encounter children requiring a delayed revascularization of the extremities.
Adequate arterial circulation is not only necessary for the treatment of cold intolerance,
but also for future limb growth and skeletal development. It is known that abnormal
ankle brachial indices correlate well with limb length discrepancies. This was a case
report of a 10-year-old girl who sustained a penetrating injury to the shoulder, lacerating
and avulsing the subclavian vessels and brachial plexus, initially treated by ligation
of the vessels and stabilization for hemorrhagic shock. She presented for the first
time 9 months after the injury with almost no motor and sensory function, stiff glenohumeral
joint, and cold intolerance in her dominant upper extremity. At the vascular physical
exam, there was no palpable radial pulse, but presence of a monophasic Doppler signal.
She underwent a simultaneous brachial plexus reconstruction and revascularization.
An extra-anatomic bypass from the first portion of the subclavian to the brachial
artery was performed with a 20-cm reversed saphenous vein graft. These authors presented
their rationale for preoperative, operative, and postoperative decision making for
a successful microvascular reconstruction and 8-months follow-up.
