Treatment of Traumatic Major Arterial Injuries of the Proximal Upper Extremity

Abstract

Traumatic major arterial injuries of the proximal upper extremity are relatively uncommon. We investigated the characteristics and postoperative outcomes of 20 arterial injuries in 19 patients. We retrospectively reviewed the medical records of the patients, consisting of 14 males and 5 females, with an average age of 39 (range 5-68) years. Patients with complete amputation of the extremity were excluded. The injuries were accompanied by fractures in 12 patients, nerve injuries in 11, muscle rupture in 8, thoracic injuries in 7, and others in 5. The average injury severity score (ISS) was 15 (range 4-41) points. Regarding surgical procedures, end-to-end anastomosis was performed for 10 arteries, vein graft for 8, and suture repair for 2. The average time of reperfusion after arterial injury was 6 hours and 38 minutes. Postoperative complications included compartment syndrome in 3 patients, skin necrosis in 2, and infection in 1. Extremities were preserved in all patients. According to the latest post-operative evaluation using Chen’s criteria, Grade I was observed in 7 patients, GradeⅡin 3, GradeⅢin 2, and GradeⅣin 7. Blunt force injury, nerve injury, fracture, and muscle rupture as accompanying injuries were significant risk factors for a poor prognosis.