Management of penetrating injuries of the upper extremities

Abstract

BACKGROUND: Routine surgical exploration after penetrating upper extremity trauma (PUET) to exclude arterial injury leads to a large number of negative explorations and iatrogenic injuries. Selective non-operative management (SNOM) is gaining in favor for patients with PUET. The present study was undertaken to assess the validity of SNOM in PUET and to present a practical management algorithm.

Stabbing Injury of the Forearm: A Case Report

“…Foreign body penetrations are common injuries and may occur in almost any part of the body [1,2]. Penetrating trauma of upper extremities are considered as difficult injuries to manage because vascular and nerve injuries are serious and may lead to catastrophic damages impairing the patient outcome [4,5].…”

“…In common practice for the treatment of this deeper penetrating injuries routine emergent exploration was performed causing a large number of iatrogenic injuries and unnecessary extremity explorations [6]. Some authors support the idea of elective non-operative management favorable for the management of penetrating injuries of the upper extremities [2]. In this case, we didn't attempt to remove the knife at the emergency department so as not to cause neurovascular damage and to avoid unnecessary morbidity we performed slight dissection into the knife tract.…”

“…Foreign body penetrations are common injuries and may occur in almost any part of the body [1,2]. Nearly half of the penetrating traumas are penetrating injuries to the extremities.…”

“…They are less common injuries in West European countries. In these countries the low incidence makes it difficult to gain experience for the trauma surgeons [2]. So as not to miss such common injuries as it can lead to drastic consequences, physicians should be more careful at the examination and treatments of such wounds.…”

A Different Approach to the Simultaneously Injured Ulnar and Radial Arteries: Translocation of an Arterial Segment

“…[8] If a further investigation is necessary, contrast-injected computerized tomography may be terminally performed. [9] Revascularization of the interrupted artery should be performed rapidly during the critical ischemic period (4 hours following the event for proximal injuries, 12 hours following the event for distal injuries). [10] If this period is exceeded, amputation due to necrosis of the extremity should be taken into consideration.…”