Stefanou N, Mylonas T, Angelis FA, Arnaoutoglou C, Varitimidis SE, Dailiana ZH. Upper extremity vascular injuries: Etiology, management and outcome. World J Crit Care Med 2024; 13(2): 91558 [PMID: 38855274 DOI: 10.5492/wjccm.v13.i2.91558]
Corresponding Author of This Article
Zoe H Dailiana, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou Street, Biopolis, Larissa 41500, Greece. dailiana@med.uth.gr
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 9, 2024; 13(2): 91558 Published online Jun 9, 2024. doi: 10.5492/wjccm.v13.i2.91558
Upper extremity vascular injuries: Etiology, management and outcome
Nikolaos Stefanou, Theodoros Mylonas, Fragkiskos A Angelis, Christina Arnaoutoglou, Sokratis E Varitimidis, Zoe H Dailiana
Nikolaos Stefanou, Theodoros Mylonas, Fragkiskos A Angelis, Christina Arnaoutoglou, Sokratis E Varitimidis, Zoe H Dailiana, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
Zoe H Dailiana, Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Larissa 41500, Greece
Author contributions: Stefanou N and Dailiana ZH participated in the conception and design of the study, analysis and interpretation of the data, drafting and critical revision of the article; Varitimidis S participated in the design of the study, and was involved with data collection and analysis and interpretation of data; Mylonas Th and Angelis Fr participated in interpretation of the data, and drafting of the article; Arnaoutoglou Ch participated in the analysis and interpretation of the data, and critical revision of the article; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the University Hospital of Larissa ethics committee.
Informed consent statement: All study participants, or their legal guardian, provided informed consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zoe H Dailiana, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 3 Panepistimiou Street, Biopolis, Larissa 41500, Greece. dailiana@med.uth.gr
Received: December 30, 2023 Peer-review started: December 30, 2023 First decision: January 16, 2024 Revised: January 28, 2024 Accepted: March 4, 2024 Article in press: March 4, 2024 Published online: June 9, 2024 Processing time: 155 Days and 20.6 Hours
ARTICLE HIGHLIGHTS
Research background
Vascular injuries of the upper extremity are rare but complex injuries affecting mostly the young population and causing chronic dysfunction.
Research motivation
The management of this type of injuries is challenging often leading to unpredictable outcomes and dissatisfied patients.
Research objectives
The objectives of this study were to analyze data about the mechanism of injury, the management algorithm and functional outcomes of vascular injuries of the upper extremity.
Research methods
This retrospective study included 115 patients that suffered an arterial injury between 2003 and 2022 and treated in a tertiary orthopaedic department. Patients with Mangled Extremity Severity Score ≥ 7 and Injury Severity Score ≥ 20, previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded, from the study. The study analyzed the demographics data of the included patients, the anatomic structures mostly involved, the management and the postoperative outcomes at a mean follow up of 7.4 years.
Research results
A penetrating trauma was the most common cause of injury. The radial artery was the artery injured in most of the cases (37.4%) followed by the ulnar (29.5%), the brachial (12.1%) and the axillary (6%). A simultaneous injury of both of the forearm’s arteries was in 15.6% of the cases. In 93% of the cases there were other concomitant musculoskeletal injuries of the extremity. Tendon lacerations were the most common followed by nerve injuries. The postoperative functional scores (full Disabilities of the Arm, Shoulder, and Hand and VAS) had very satisfactory values.
Research conclusions
In cases of complex injuries of the upper extremity, primary arterial repair is indicated in stable patients if both radial and ulnar arteries are damaged or in the presence of an axillary or brachial arteries injury. A multidisciplinary approach is essential to optimize postoperative outcome. The ability of trained orthopaedic hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma, excluding isolated vascular injuries, ensures better functional outcomes.
Research perspectives
The different methods for the diagnosis and management of severe, vascular injuries of the upper extremity were studied.
