Idiopathic neonatal ischemia in the upper limb: the role of the microsurgeon

Idiopathic neonatal limb ischemia remains a rare occurrence. It is a devastating process that leads to complete or partial loss of affected limb or severe deformity. The main treatments over the years have been conservative and nonsurgical, such thrombolysis. Surgical treatment has traditionally been delayed until a line of demarcation is clear, at which time amputation of the limb proceeds. We present a case of idiopathic upper limb ischemia in a newborn, where it was clear that nonsurgical management would result in limb necrosis. A thrombus extended from the brachial bifurcation into both ulnar and radial arteries to the wrist. The plastic surgery team performed surgical decompression and microsurgical open thrombectomy to successfully reestablish the circulation to the affected hand. Eight months later, the child remains well. This is the first reported case in the literature where an idiopathic thrombus blocking the brachial, radial, and ulnar arteries is successfully treated microsurgically.