Year Book: Management of Arm *Arterial* Injuries

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Sitzmann-James-V. Ernst-Calvin-B. 1986 Year Book of Hand Surgery. Article 3-3. Original Article: Surgery. 1984 Nov. 96. pp 895-901. A review was made of data on 102 patients treated at Johns Hopkins Medical Institutions in 1971-1981 for 109 *arterial* injuries involving vessels from the thoracic inlet to the wrist. The 83 male and 19 female patients in the series had an average age of 28 years. Thirty-six upper arm and 73 lower arm *arterial* injuries were treated. All injuries but 4 resulted from penetrating *trauma.* The clinical features are given in the table. Most subclavian artery injuries were managed by end-to-end repair after debriding injured tissue. None of the 13 patients required amputation, and none had disability from the *arterial* injury itself. Three of 7 patients with axillary artery injuries required saphenous vein interposition grafts. One vein graft that thrombosed postoperatively was corrected by Dacron graft repair. Seven of 16 patients with brachial artery injuries had vein grafting, and 7 had end-to-end repair. Wrist pulses were restored in the patients who underwent reconstruction. Two patients required forearm fasciotomy after blood flow was restored. Most radial artery injuries were managed by end-to-end repair. Only 1 of 30 patients required vein graft interposition. *Arterial* ligation was done in 10 patients. Twelve of 20 patients having reconstruction had palpable distal pulses postoperatively. No amputations were necessary. Nineteen of the 28 patients with ulnar artery injury had end-to-end *arterial* repair. None of 6 patients with both radial and ulnar *arterial* injuries had vascular disability. Both interosseous injuries were managed by ligation. *Arterial* injuries in the upper arm are more life-threatening than are more distal injuries, but the latter are more disabling, chiefly because of associated nerve involvement. Suspicion of vascular injury is sufficient indication for arteriography. Most injuries were managed by limited resection with end-to-end anastomosis. Autogenous saphenous vein is preferred when grafting is required. Of the lower arm injuries, 25 per cent were managed by *arterial* ligation without adverse sequelae. Fasciotomy was performed in 5 patients because of severe preexisting ischemia and reperfusion compartmental compression.