Traumatic Musculoskeletal Changes in Forearm and Hand After Emergency Vascular Anastomosis or Ligation

Author(s): Bassetto F, Zucchetto M, Vindigni V, et al.

Source: J Reconstr Microsurg 26(7) 1098-8947,  2010.

Summary:

This retrospective study evaluates 53 patients with sharp forearm injuries that involved repair or ligation of the radial, ulnar, or both arteries during management.  All patients had clinically adequate flow to their hands and forearms via collateral flow at the time of evaluation for repair or ligation. Repaired arteries were assessed for patency and collateralization was evaluated in all limbs using magnetic resonance angiography and color flow Doppler. Cortical and trabelcular bone mineral density (BMD) were evaluated at the proximal radius (proximal to zone of injury), distal radius, and proximal phalanx of the middle finger in all patients.  Lean muscle mass and forearm strength using contralateral and age-matched controls were also assessed.  Average follow-up was 11 years. 

Of the 53 included patients, 44 had repaired or reconstructed arteries and 16 had ligations performed.  Of those with repairs/reconstructions, 75% remained patient at the time of follow-up. Results demonstrated statistically significant reductions in BMD in the distal radius and proximal phalanges in those with ligated arteries or arteries which had been repaired but occluded. These results were controlled for concomitant nerve injury.

Subjective symptoms of paresthesia, hypothermia, and hypoesthesia, which were not specifically addressed in the methods of the study, were felt to be more consistent with the level of nerve injury than vascular repair.  Muscle mass and strength were better in those with repaired arteries, although this data was not as straightforward.  The degree of BMD reduction was approximately 0.5 standard deviations from age matched normal and contralateral internal controls.  The authors speculate that this results in a 1.5 times higher probability of wrist fracture in those with ligated arteries.  The authors recommend that when possible, arterial reconstruction be performed even in instances where distal perfusion does not seem impaired to do clinically adequate collateral flow.