Published online Jun 9, 2024. doi: 10.5492/wjccm.v13.i2.91558
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
Vascular injuries of the upper extremity are rare but complex injuries affecting mostly the young population and causing chronic dysfunction.
The management of this type of injuries is challenging often leading to unpredictable outcomes and dissatisfied patients.
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.
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.
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.
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.
The different methods for the diagnosis and management of severe, vascular injuries of the upper extremity were studied.