Management of acute arterial trauma of the upper extremity.

During a 3.5 year period ending in September 1991, 50 patients with 51 arterial injuries of the upper extremity were operated on and followed up for more than 6 months. The majority of the cases suffered penetrating injuries, but in 18% blunt trauma led to thrombosis. The most frequently observed signs were haemorrhage, neurological disorders and a peripheral pulse deficit. The brachial artery was most frequently injured. Preoperative arteriography was performed in 20% and peroperative angiography in 16% of cases. Reconstructive surgery was performed in 88% and the brachial artery was ligated in a single patient who was in shock. An end to end anastomosis was possible in 55% and in 45% of cases an autogenous vein graft was used. A microsurgical technique was used in cases of forearm arterial injuries. In five patients with prolonged ischaemia, forearm fasciotomies were needed. Additional procedures such as venous, bone or nerve repair was also necessary. In four cases a temporary shunt was used. All patients were alive with late patency of 91% in the axillobrachial arterial segment. A single failure after repeated brachial artery reconstruction was observed following severe traumatic amputation with large tissue defects. Post-operative arteriography revealed a good anastomosis with patent grafts. Arterial reconstruction is clearly necessary in these injuries and we believe that an experienced vascular surgeon should be involved.