Gustilo IIIc Open Fracture of the Humerus Treated with a Long Vein Graft : A Case Report

Abstract

A 62-year-old woman exhibited a Gustilo type IIIc open fracture of the right humerus with a long defect of the brachial artery. The injury was due to the patient's upper extremity protruding through a window during a motor vehicle rollover. The patient's overall health status was stable, and reconstruction was attempted. After debridement and external fixation of the humerus, the brachial artery was reconstructed with a reverse great saphenous vein graft of 220 mm in length. The duration of ischemia was 6.5 hours. Graft patency was demonstrated by ultrasonography 10 months after the injury. Most of the brachial artery injuries were caused by puncture wounds to the upper extremity. Our case involved a “hand-out-the-window” injury during a traffic accident. Although there was good collateral circulation around the elbow joint, the patient had a large soft-tissue injury including the brachial artery and its branches; therefore, revascularization with a vein graft was needed for limb salvage.