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Radial, Ulnar, and Hand Injuries

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Clinical Review of Vascular Trauma

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Abstract

Trauma to the forearm and hand comprises nearly one-third of all upper extremity vascular injuries, often leading to complex injuries leading to significant loss of function due to concomitant nerve and muscle injury. Penetrating trauma is the most common cause of upper extremity vascular injury, and mastery of the anatomy of the distal upper extremity is essential to appropriate surgical management. Stabilization of any accompanying fractures precedes vascular repair; temporary shunting can be utilized in cases of profound ischemia. Primary repair can often be accomplished, but conduit using autogenous vein can be used when direct apposition of the vessel is not appropriate. Trauma to the radial artery can sometimes be addressed with simple ligation. However, this is not an option in patients who do not have a normally dominant ulnar artery. Duplication of the digital arteries typically permits loss of one of the two vessels to the fingers. Endovascular techniques have been described for the management of distal upper extremity trauma, but are not yet mainstream options. A multidisciplinary approach to the management of upper extremity trauma is essential to maximizing limb salvage rates and avoiding unnecessary morbidity and mortality.

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References

  1. Perry MO, Thal ER, Shires GT. Management of arterial injuries. Ann Surg. 1971;173(3):403–8.

    Article  PubMed  CAS  Google Scholar 

  2. Prichayudh S, Verananvattna A, Sriussadaporn S, Sriussadaporn S, Kritayakirana K, Pak-art R, et al. Management of upper extremity vascular injury: outcome related to the Mangled Extremity Severity Score. World J Surg. 2009;33(4):857–63.

    Article  PubMed  Google Scholar 

  3. Klocker J, Falkensammer J, Pellegrini L, Biebl M, Tauscher T, Fraedrich G. Repair of arterial injury after blunt trauma in the upper extremity – immediate and long-term outcome. Eur J Vasc Endovasc Surg. 2010;39(2):160–4.

    Article  PubMed  CAS  Google Scholar 

  4. Joshi V, Harding GE, Bottoni DA, Lovell MB, Forbes TL. Determination of functional outcome following upper extremity arterial trauma. Vasc Endovascular Surg. 2007;41(2):111–4.

    Article  PubMed  Google Scholar 

  5. Diamond S, Gaspard D, Katz S. Vascular injuries to the extremities in a suburban trauma center. Am Surg. 2003;69:848–51.

    PubMed  Google Scholar 

  6. Van der Sluis CK, Kucey DS, Brenneman FD, et al. Long-term outcomes after upper limb arterial injuries. Can J Surg. 1997;40:265–70.

    PubMed  Google Scholar 

  7. Bongard F, Dubrow T, Klein S. Vascular injuries in the urban battleground: experience at a metropolitan trauma center. Ann Vasc Surg. 1990;4(5):415–8.

    Article  PubMed  CAS  Google Scholar 

  8. Tan TW, Joglar FL, Hmaburg NM, Eberhardt RT, et al. Limb outcome and mortality in lower and upper extremity arterial injury: a comparison using the National Trauma Data Bank. Vasc Endovascular Surg. 2010;45(7):592–7.

    Article  Google Scholar 

  9. Rozycki GS, Tremblay LN, Feliciano DV, McClelland WB. Blunt vascular trauma in the extremity: diagnosis, management, and outcome. J Trauma. 2003;55(5):814–24.

    Article  PubMed  Google Scholar 

  10. Bravman JT, Ipaktchi K, Biffl WL, Stahel PF. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential “near miss” injuries. Scand J Trauma. 2008;16:16.

    Article  Google Scholar 

  11. Starnes BW, Arthurs ZM. Endovascular management of vascular trauma. Perspect Vasc Surg Endovasc Ther. 2006;18(2):114–29.

    Article  PubMed  Google Scholar 

  12. Smith HE, Dirks M, Patterson RB. Hypothenar hammer syndrome: Distal ulnar artery reconstruction with autologous inferior epigastric artery. J Vasc Surg. 2004;40(6):1238–42.

    Article  PubMed  Google Scholar 

  13. Deakin CD, Low JL (Sept 2000). “Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study” American College of Surgeons. Advanced trauma life support program for physicians. 7th ed. Chicago; 2004.

    Google Scholar 

  14. Moore EE, Feliciano DV, Mattox KL. Trauma. 5th ed. New York: McGraw-Hill Publishers; 2004.

    Google Scholar 

  15. Swan Jr KG, Wright DS, Barbagiovanni SS, Swan BC, Swan KG. Tourniquets revisited. J Trauma. 2009;66(3):6672–5.

    Article  Google Scholar 

  16. Odinsson A, Finsen V. The position of the tourniquet on the upper limb. J Bone Joint Surg Br. 2002;84(2):202–4.

    Article  PubMed  CAS  Google Scholar 

  17. American College of Surgeons Committee on Trauma. Guide to prophylaxis against tetanus in wound management. Chicago: American College of Surgeons; 1983.

    Google Scholar 

  18. Ejrup B, Fischer B, Wright IS. Clinical evaluation of blood flow to the hand. The false-positive Allen test. Circulation. 1966;33(5):778–80.

    Article  PubMed  CAS  Google Scholar 

  19. Benit E, Vranckx P, Jaspers L, Jackmaert R, Poelmans C, Coninx R. Frequency of a positive modified Allen’s test in 1,000 consecutive patients undergoing cardiac catheterization. Cathet Cardiovasc Diagn. 1996;38(4):352–4.

    Article  PubMed  CAS  Google Scholar 

  20. Franz RW, Skytta CK, Shah KJ, et al. A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg. 2012;26(5):655–64.

    Article  PubMed  Google Scholar 

  21. Shanmugam V, Velu RB, Subramaniyan SR, et al. Management of upper limb arterial injury without angiography -Chennai experience. Injury. 2004;35:61e4.

    Article  Google Scholar 

  22. Cunningham PR, Cushman M. Management of vascular trauma. J Natl Med Assoc. 1987;79(7):721–5.

    PubMed  CAS  Google Scholar 

  23. Franz RW, Goodwin RB, Hartman JF, Wright ML. Management of upper extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg. 2009;23:8e16.

    Google Scholar 

  24. Rowe VL, Yellin AE, Weaver FA. Vascular injuries of the extremities. In: Rutherford RB, editor. Vascular surgery. 6th ed. Philadelphia: Elsevier Saunders; 2005. p. 1001e6.

    Google Scholar 

  25. Rich NM, Hughes CW. The fate of prosthetic material used to repair vascular injuries in contaminated wounds. J Trauma. 1972;12(5):459–67.

    Article  PubMed  CAS  Google Scholar 

  26. Masden DL, Seruya M, Higgins JP. A systemic review of the outcomes of distal upper extremity bypass surgery with arterial and venous conduits. J Hand Surg Am. 2012;37(11):2361–7.

    Article  Google Scholar 

  27. Huang JJ, Wu CW, Lam W, Nguyen DH, Kao HK, Lin CY, Cheng MH. Anatomical basis and clinical application of the ulnar forearm free flap for head and neck reconstruction. Laryngoscope. 2012;122:2670–6.

    Article  PubMed  Google Scholar 

  28. Lovie MJ, Duncan GM, Glasson DW. The ulnar artery forearm free flap. Br J Plast Surg. 1984;37(4):486–92.

    Article  PubMed  CAS  Google Scholar 

  29. Unal C, Ozdemir J, Hasdemir M. Clinical application of distal ulnar artery perforator flap in hand trauma. J Reconstr Microsurg. 2011;27(9):559–65.

    Article  PubMed  Google Scholar 

  30. Cohen JE, Ben-Hur T, Rajz G, Umansky F, Gomori JM. Endovascular stent-assisted angioplasty in the management of traumatic internal carotid artery dissections. Stroke. 2005;36(4):e45–7.

    Article  PubMed  Google Scholar 

  31. Kerby JD, May AK, Gomez CR, Rue III LW. Treatment of bilateral blunt carotid injury using percutaneous angioplasty and stenting: case report and review of the literature. J Trauma. 2000;49(4):784–7.

    Article  PubMed  CAS  Google Scholar 

  32. Lonn L, Delle M, Karlstrom L, Risberg B. Should blunt arterial trauma to the extremities be treated with endovascular techniques? J Trauma. 2005;59(5):1224–7.

    PubMed  Google Scholar 

  33. Maynar M, Baro M, Qian Z, et al. Endovascular repair of brachial artery transection associated with trauma. J Trauma. 2004;56(6):1336–41.

    Article  PubMed  Google Scholar 

  34. Bravman JT, Ipaktchi K, Biffl WL, Stahel PF. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential “near miss” injuries. Scand J Trauma Resusc Emerg Med. 2008;16(1):16.

    Article  PubMed  Google Scholar 

  35. Gelberman RH, Garfin SR, Hergenroeder PT. Compartment syndrome of the forearm: diagnosis and treatment. Clin Orthop. 1981;161:252–61.

    PubMed  Google Scholar 

  36. Whitesides TE, Harney TC, Harada H, et al. A simple method for tissue pressure determination. Arch Surg. 1975;110:1311–3.

    Article  PubMed  Google Scholar 

  37. Mubarak SJ, Owen CA, Hargens AR, et al. Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am. 1978;60(8):1091–5.

    PubMed  CAS  Google Scholar 

  38. Mubarak SJ, Hargens AR, Owen CA, et al. The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am. 1976;58(7):1016–20.

    PubMed  CAS  Google Scholar 

  39. Matsen FA, Winquist RA, Krugmire RB. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. 1980;62:286–91.

    PubMed  Google Scholar 

  40. Moed BR, Thorderson PK. Measurement of intracompartmental pressure: a comparison of the slit catheter, side-ported needle, and simple needle. J Bone Joint Surg Am. 1993;75(2):231–5.

    PubMed  CAS  Google Scholar 

  41. Elliot KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br. 2003;85(5):625–32.

    Google Scholar 

  42. Luber KT, Rehm JP, Freeland AE. High-pressure injection injuries of the hand. Orthopedics. 2005;28(2):129–32.

    PubMed  Google Scholar 

  43. Ouelette EA, Kelly R. Compartment syndrome of the hand. J Bone Joint Surg Am. 1996;78(10):1515–22.

    Google Scholar 

  44. Mannord JD, Garrard CL, Kline DG, Sternberg EC, et al. Management of severe proximal vascular and neural injury of the upper extremity. J Vasc Surg. 1998;1:43–7.

    Article  Google Scholar 

  45. Fields CE, Latifi R, Ivatury RR. Brachial and forearm vessel injuries. 1. Surg Clin North Am. 2002;82(1):105–14.

    Article  PubMed  Google Scholar 

  46. Brown KR, Jean-Claude J, Seabrook GR, et al. Determinates of functional disability after complex upper extremity trauma. Ann Vasc Surg. 2001;15:43e8.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Hofstra North Shore – LIJ School of Medicine, Hempstead, NY, USA

    Victor A. Moon MD

  2. Departments of Plastic Surgery and General Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    John B. Hijjawi MD

Authors
  1. Victor A. Moon MD
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  2. John B. Hijjawi MD
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Editor information

Editors and Affiliations

  1. Department of Surgery MSB 5.030, Center for Translational Injury Research, Houston, Texas, USA

    Anahita Dua

  2. Department of Surgery, University of Texas-Houston Duke University School of Medicine, Houston, Texas, USA

    Sapan S. Desai

  3. Department of Surgery, University of Texas-Houston, Houston, Texas, USA

    John B. Holcomb

  4. Department of Orthopedics, University of Texas-Houston, Houston, Texas, USA

    Andrew R. Burgess

  5. Department of Surgery, John Hopkins Medical Institutions, Baltimore, Maryland, USA

    Julie Ann Freischlag

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© 2014 Springer-Verlag Berlin Heidelberg

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Moon, V.A., Hijjawi, J.B. (2014). Radial, Ulnar, and Hand Injuries. In: Dua, A., Desai, S., Holcomb, J., Burgess, A., Freischlag, J. (eds) Clinical Review of Vascular Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39100-2_10

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  • DOI: https://doi.org/10.1007/978-3-642-39100-2_10

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-39099-9

  • Online ISBN: 978-3-642-39100-2

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