Reconstructive Arterial Surgery in Upper-Extremity Injuries

¹ Departments of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston

A plea is immade for primary restoration of arterial continuity in cases of upper-extremity traunma involving injury to major arteries. This is justified by the high incidence of limb loss in such injuries and is particularly important where there is conconmitant injury in the distal, relatively ischaemic portion of the extremity. Such efforts can be rewarding even in late and neglected cases. Excellent flow through the reconstructed vessel is essential to success. This requires scrupulous attention to the avoidance of stricture at the suture line and complete removal of distal thrombus in the artery. The latter can be accomplished by retrograde flushing or by the use of instruments from an unthrombosed point in the distal portion of the artery. Re-exploration in the event of postoperative thrombosis is urged since this frequently will convert failure to success if the reason for thrombosis is recognized and corrected. The free use of venous autografts is recommended. Extremes of heat and cold are to be avoided in the extremity with marginal circulation since both can cause serious tissue injury. The extremity should be warmed to a temperature of from 80 to 90 degrees Fahrenheit. Even severe degrees of ischaemic injury resulting from long periods of circulatory arrest will heal and allow salvage of a useful extremity if the circulation is restored. Conservatism is urged in the treatment of such cases.

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