Management of upper extremity arterial penetrating vascular trauma

Published:October 07, 2021DOI:https://doi.org/10.1016/j.injury.2021.10.001

      Highlights

      • Critical penetrating vascular injuries, in addition to arterial repair, often require one or more of the following: fastidious debridement; rigid stabilization, for associated fractures; ligamentous repair for unstable joints; neurroraphy without tension; tendon repairs and or transfers; and therapeutic or prophylactic fasciotomy.
      • Civilian versus military and terrorist-related injuries are very different and require alternative treatment algorithms.
      • Assuming successful arterial repair, the management of soft tissue damage, fractures, dislocations, nerve injuries, tendon disruption, and skin coverage are major determinants of function.

      Abstract

      Penetrating vascular injuries in the upper extremity are relatively uncommon; suboptimal treatment may result in significant morbidity including amputation. Arterial trauma accounted for 68% of amputations (24% in the upper extremity) during World War II. Although surgical techniques including microsurgical principles have matured, results vary secondary to the mechanism of injury, systemic factors, anatomic considerations and physiologic events.
      This annotated review article is based upon the literature and the author's 42 years of vascular trauma experience including over 1500 revascularizations and replantations. It discusses the complex interplay of associated injuries; the mechanism of injury, the location of the injury; the collateral circulation; the extent of soft tissue damage; the adequacy of debridement; the significance of pre-existing conditions; and magnitude of wound contamination. Based upon this evaluation, a guide to indications for arterial reconstruction is provided and a comprehensive management plan for vascular trauma may be derived.

      Keywords

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