Management of acute arterial trauma of the upper extremity

Andreev, Andreia; Kavrakov, Tanyo; Karakolev, J.; Penkov, P

doi:10.1016/s0950-821x(05)80833-3

Cited by 31 publications

(15 citation statements)

References 14 publications

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“…Upper extremity arterial injuries constitute up to 50% of peripheral vascular injuries. 1 – 2 Penetrating injury to the forearm is a less common subset of upper extremity trauma. Lacerations of the forearm and wrist by knife, glass or machinery (often from occupational injury), are frequent to both the radial and ulnar arteries.…”

Section: Introductionmentioning

confidence: 99%

Evidence-based Comprehensive Approach to Forearm Arterial Laceration

Thai¹,

Pacheco²,

Margolis³

et al. 2015

WestJEM

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IntroductionPenetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge.DiscussionThe optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of arterial perfusion. In a well-perfused hand, however, the presence of one intact artery is adequate to sustain viability without long-term functional disability, provided the palmar arch circulation is intact. Early consultation with a hand specialist should be pursued, and follow-up arrangement made for delayed primary repair in cases of complex injury.ConclusionManagement in accordance with well-established clinical principles will maximize treatment efficacy and functional outcome while minimizing the cost of medical care.

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Section: Introductionmentioning

confidence: 99%

Evidence-based Comprehensive Approach to Forearm Arterial Laceration

Thai¹,

Pacheco²,

Margolis³

et al. 2015

WestJEM

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“…All these factors contribute to the difficulty in determining the arterial damage and injury severity in the upper extremity crush injuries. [21][22][23][24] The severity of the arterial injury can be assessed more accurately with the combination of imaging data, histopathological assessment, and the direct intraoperative visualization. [19,20] Optimal treatment can be also suggested accordingly, which should be the priority of the developing treatment guidelines for the artery injuries.…”

Section: Discussionmentioning

confidence: 99%

Histopathological evaluation of the arterial wall damage in upper limb injuries

Özçınar¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, üst ekstremite ezilme yaralanmaları arter duvarındaki histopatolojik değişikliklere göre değerlendirildi ve erken ve geç dönem klinik sonuçlar bildirildi.Ça lış ma pla nı: Şubat 2011 -Kasım 2013 tarihleri arasında üst ekstremite ezilme yaralanması olan 12 hastanın (9 erkek, 3 kadın; ort. yaş 33.3±11.7 yıl; dağılım 18-57 yıl) prospektif olarak toplanan verileri retrospektif olarak incelendi. Hastaların tümünün Ezilmiş Ekstremite Şiddet Skoru ≥7 idi ve tümünde ciddi vasküler yaralanma bulguları vardı. Ortopedik stabilizasyon sonrasında vasküler rekonstrüksiyon yapıldı. Hemodinamik stabilizasyon sonrasında, rutin olarak dijital substraksiyon anjiyografi çekildi. Revaskülarizasyon işlemi sırasında, hasarlı arter damarları çıkarıldı ve formalin solüsyonunda saklandı. Endotelyal şişme, intimal kalınlaşma, kas tabakasındaki hücresel vaküolizasyon, tunika medyadaki ödem ve nekrozun derecesi değerlendirildi.Bul gu lar: Yaralanma beş hastada işe bağlı kazalar ve yedi hastada motorlu araç kazaları ile ilişkiliydi. Tüm hastalara ven greft interpozisyonu uygulandı (12; %100). Primer açıklık oranı %75 idi ve bir hasta kaybedildi (30 günlük mortalite %8.3). On iki hastada üç amputasyon yapıldı. Medyan takip süresi 3.2 (dağılım: 2.1-3.7) yıl idi. Alınan örneklerin mikroskopik incelemesinde vasküler konjesyon ve trombüs oluşumu, ilerleyici subintimal diseksiyon ve elastik internanın membranında yırtılma olduğu belirlendi.So nuç: Çalışma sonuçlarımız Ezilmiş Ekstremite Şiddet Skoruna göre amputasyon endikasyonu olsa da, ekstremite kurtarma işlemlerinin uygulanmasını önermektedir.Anah tar söz cük ler: Ezilme yaralanması; patolojik değerlendirme; üst ekstremite revaskülarizasyonu. ABSTRACTBackground: This study aims to evaluate the upper limb crush injuries according to the histopathological changes in the arterial vessel and to report the early and late clinical outcomes.

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“…Primary repair of the artery is undertaken if the gap or defect is small. 1 Large gaps, as in this case, are best reconstructed with autologous vein grafts, such as a reversed saphenous graft.…”

Section: Discussionmentioning

confidence: 99%