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Arterial Injury of Forearm in Well-perfused Limb: Can it Wait?
Min Jung Park, MD, MMSc1; Itai Gans, BA2; Ines C. Lin, MD2; Benjamin Chang, MD3; L. Scott Levin, MD, FACS1; David J. Bozentka, MD2; David R. Steinberg, MD1;
1University of Pennsylvania, 2Hospital of the University of Pennsylvania, 3University of Pennsylvania Health System
Purpose
The purpose of this study is to evaluate whether there is difference in outcome for patients who were taken to the OR within 6 hours for forearm arterial injury with a well-perfused hand and patients who were treated in delayed fashion. We hypothesize that there is no difference in clinical outcome in patients who were taken to the OR emergently.
Method
A retrospective review of 181 consecutive patients who were taken to the OR with forearm-level radial or ulnar arterial injury identified 18 patients who had a well-perfused hand at presentation with single artery laceration, in whom hemostasis was achieved within 15 minutes with manual pressure with no signs of hemodynamic instability. Outcomes of interest included quickDASH and patient-reported cold intolerance.
Results
Of the 18 patients, group 1 included 11 patients who were taken to the OR within 6 hours, and group 2 included 7 patients who were taken to the OR in delayed fashion (range 7- 64 hours) after careful monitoring of hemodynamic status. All patients had their arterial injury primarily repaired. Minimum follow-up in both groups was 3 months (group 1 average: 6.7, group 2 average: 7.2). Average quickDASH score was 33.1 and 14.3 for group 1 and group 2, respectively (p = 0.1). Two out of 11 patients in group 1 reported cold intolerance (one ulnar artery repair and one radial artery repair with palpable pulses at 6 and 8 months follow up, respectively) compared to no patients in group 2. The ratio of radial and ulnar artery injuries were 5:6 in group 1 and 4:3 in group 2. The associated injuries in both groups were flexor tendons, median, and/or ulnar nerve and were addressed at time of arterial repair. All patients had at least one other associated injury, and there was no difference between group 1 and group 2 in terms of the number of tendon and/or nerve injury.
Conclusion
In the setting of forearm arterial injury with a well-perfused distal limb where hemostasis can be achieved with pressure dressing, we find no difference in clinical outcomes of patients taken to the OR emergently compared to those who underwent surgery within 64 hours. With careful evaluation and monitoring, delayed operative repair within 3 days is feasible and may improve certain aspects of patient care and hospital resource utilization.
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