Brachial Plexus and subclavian artery

justAnotherWriter · Mar 14, 2010

I need a surgeon for this one...

If a person recieves a sword wound to the shoulder that cuts through the clavicle, brachial plexus and subclavian artery, can this person survive such a wound, IF:

1. There is a team of surgeons and a prepped OR standing by within a hundred feet.
2. There are either doctors or paramedics at the scene to clamp the artery within 30 seconds of the wound.

If it is survivable, can the damage be completely repaired, with minimal scarring and full mobility restored to the arm under those same conditions? Can a very good surgeon repair the brachial plexus if the injury is precise, surgical even, and the patient goes to the OR within moments of the injury?

Thanks in advance, and much appreciated.

ColoradoGuy · Mar 14, 2010

I'm not a surgeon, but I do practice intensive care medicine and care for a lot of injured folks, many of whom have had various kinds of surgery.

Clavicular injuries are no big deal -- they heal more or less by themselves. I was taught that the bone will heal "as long as the two broken ends are in the same room with each other."
Severe brachial plexus injuries will most likely leave residual damage that won't heal. It's a pretty complicated meshwork of nerves. It would be hard for your character to recover complete function, although you could make the nerve injury less severe if your plot needs that.
The subclavian artery isn't really easily accessible for clamping off unless the shoulder is opened up with a pretty large wound. An injury to the subclavian would bleed quite a bit, but it would not necessarily be fatal. A person could make a complete recovery from that.

Time to surgery wouldn't matter that much for an injury like that as long as the bleeding could be slowed down. An injury in that area often injures the lung, the top of which is very close to those structures. For example, now and then we inadvertently puncture the subclavian artery or the top of the lung when we are placing venous catheters into the subclavian vein, which runs nearby. If your character's injury involves the lung, collapse of the lung often causes immediate breathing problems that need to be dealt with within a few minutes or so. Otherwise you wouldn't need to have an operating room immediately available.

justAnotherWriter · Mar 14, 2010

Thanks, that's very helpful.

As far as the artery, yes, the shoulder will be wide open...a sword wound is a gruesome thing, however clean and precise.

Regarding the brachial plexus, if it was severed neatly, and you had the world's best surgeon and his runner up ready to go, can they restore 100% mobility?

justAnotherWriter · Mar 14, 2010

btw...this is the injury in question:

ColoradoGuy · Mar 14, 2010

justAnotherWriter said:
Thanks, that's very helpful.

As far as the artery, yes, the shoulder will be wide open...a sword wound is a gruesome thing, however clean and precise.

Yes. I've not seen swords, but I have seen more than a few injuries from knives, fence posts, farm machinery, and assorted other objects.

Regarding the brachial plexus, if it was severed neatly, and you had the world's best surgeon and his runner up ready to go, can they restore 100% mobility?

Not likely, but not impossible either. The brachial plexus is not a single nerve, but a plexus of them, a meshwork of twigs and branches. But you're writing a novel, not a medical treatise. Make it a good story and your readers won't care about probabilities.

ColoradoGuy · Mar 14, 2010

justAnotherWriter said:
btw...this is the injury in question:

That would be a tough one to fix. It looks like it would involve the scapula, the lung, some muscle severing, and the shoulder joint itself, at least as you've drawn it. Survivable, sure, but I can't imagine restoring complete function of the arm afterwards.

justAnotherWriter · Mar 14, 2010

ColoradoGuy said:
That would be a tough one to fix. It looks like it would involve the scapula, the lung, some muscle severing, and the shoulder joint itself, at least as you've drawn it. Survivable, sure, but I can't imagine restoring complete function of the arm afterwards.

Well, I can always make it a bit less of a gash.

But again...world's best surgeon, state of the art OR...could he do it?

ColoradoGuy · Mar 14, 2010

justAnotherWriter said:
Well, I can always make it a bit less of a gash.

But again...world's best surgeon, state of the art OR...could he do it?

Sure -- it's not inconceivable. And it's fiction, after all.

justAnotherWriter · Mar 14, 2010

ColoradoGuy said:
. But you're writing a novel, not a medical treatise. Make it a good story and your readers won't care about probabilities.

But I will. Like some writers, I get very emotionally involved with some of my characters. It's important to me that her recovery be as plausible as posisble under the circumstances.

EDIT: I wanted to add that if anyone else has any input, I'd be glad to hear it. I've already spoken to several surgeons about this, but they all have different opinions.

boron · Mar 15, 2010

At my place, a mowing machine has cut off the foot of a 10 year (I think) boy somewhere at the level of his ankle. His father has put the cut foot in a plastic bag and take his son and the foot to the hospital (in an hour or so). Surgeons have connected bones, tendons, vessels and nerves, and the boy can walk normally. I don't think, 100% recovery is likely, though. There can be some tingling, numbness, a small limit in a range of moving, occasional pains during certain movements, and such.

GeorgeK · Mar 17, 2010

Ok, What Coloradoguy told you is probably true for those patients who make it to the ICU. In the ER is different than on the scene and different than the ICU. I did a few years of trauma surgery and that picture gave me the "Holy Friggin Shi#" moment. The subclavian artery comprises something like 5 to 10% of the cardiac output. If you sever that you are likely going to die. If you are next door to a MASH unit, then you have a reasonable chance of surviving. (Emphasis on chance). Add lung damage to the scene and the chance drops.

Assuming the person survived there will be the nerve damage such that in a few years they might start to be able to use that arm again.

justAnotherWriter · Mar 17, 2010

Thank you.

After all the input here and the conversations with surgeons I know, I've devided to lessen the severity of the injury a bit...it will cut the clavicle and a small part of the barchial plexus but not the artery, and the draw cut will continue down the front of the chest to the same level as the picture without going all the way through.

I've essentially tiled the the sword up 45 degrees.

Thanks for all the help.

Brachial Plexus and subclavian artery

justAnotherWriter

ColoradoGuy

I've seen worse.

justAnotherWriter

justAnotherWriter

ColoradoGuy

I've seen worse.

ColoradoGuy

I've seen worse.

justAnotherWriter

ColoradoGuy

I've seen worse.

justAnotherWriter

boron

Health writer

GeorgeK

ever seeking

justAnotherWriter