Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
Division of Trauma and Surgical Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
J Surg Res. 2023 Nov;291:507-513. doi: 10.1016/j.jss.2023.07.015. Epub 2023 Aug 2.
Traumatic injuries to the radial and/or ulnar arteries represent a subset of arterial injuries. In the absence of injury to both forearm arteries, treatment was historically ligation if perfusion was maintained to the hand via the uninjured vessels or adequate collateral vessels. We sought to determine management of traumatic forearm arterial injuries in 2019 and to identify risk factors for major upper extremity amputation.
The American College of Surgeons Trauma Quality Improvement Program database was queried by International Classification of Diseases 10 code for patients with traumatic radial and/or ulnar artery injuries within the year 2019. Patient demographics, Injury Severity Score, time to operating room, type of repair, outcomes, and mortality were collected. Multivariable logistic regression was used to identify risk factors for major upper extremity amputation.
A total of 4048 patients with traumatic radial and/or ulnar artery injuries were identified. A total of 1907 radial artery operations were performed including repair (59%), ligation (29%), and interposition bypass (12%). A total of 1637 ulnar artery operations were completed including repair (67%), ligation (21%), and interposition bypass (12%). Major upper extremity amputation occurred in 0.6%. Older age (adjusted odds ratio [AOR]: 1.014, 95% confidence interval [CI]: 1.004-1.024, P = 0.0048), blunt mechanism (AOR: 2.457, 95% CI: 1.730-3.497, P < 0.0.0001), and ipsilateral radial and ulnar artery injury (AOR: 2.148, 95% CI: 1.298-3.553, P = 0.0029) were associated with major amputation. Surgical revascularization, time to operating room, fasciotomy, and compartment syndrome were not associated with major amputation, but this may be secondary to Type II error.
In the operating room, radial and ulnar artery injuries were managed more often with restoration of flow versus ligation. Older age, blunt mechanism, and ipsilateral radial and ulnar artery injury were associated with major amputation. Amputation rate was low at 3% overall and 0.6% for amputation of the hand or a more proximal level. Upper extremity fracture, upper extremity nerve injury, and ipsilateral radial and ulnar artery injury were associated with need for revision operation.
桡动脉和/或尺动脉的创伤性损伤是动脉损伤的一个亚组。在未同时损伤前臂的两条动脉的情况下，如果未受伤的血管或足够的侧支血管仍向手部提供灌注，则历史上的治疗方法是结扎。我们旨在确定 2019 年创伤性前臂动脉损伤的处理方法，并确定主要上肢截肢的危险因素。
通过国际疾病分类第 10 编码，从美国外科医师学会创伤质量改进计划数据库中查询 2019 年内桡动脉和/或尺动脉创伤性损伤的患者。收集患者的人口统计学资料、损伤严重程度评分、到手术室的时间、修复类型、结果和死亡率。多变量逻辑回归用于确定主要上肢截肢的危险因素。
共确定了 4048 例桡动脉和/或尺动脉创伤性损伤患者。共进行了 1907 例桡动脉手术，包括修复（59%）、结扎（29%）和间置旁路（12%）。共完成了 1637 例尺动脉手术，包括修复（67%）、结扎（21%）和间置旁路（12%）。主要上肢截肢发生率为 0.6%。年龄较大（调整后的优势比[OR]：1.014，95%置信区间[CI]：1.004-1.024，P=0.0048）、钝性机制（OR：2.457，95%CI：1.730-3.497，P<0.0001）和同侧桡动脉和尺动脉损伤（OR：2.148，95%CI：1.298-3.553，P=0.0029）与主要截肢有关。手术血运重建、到手术室的时间、筋膜切开术和筋膜间室综合征与主要截肢无关，但这可能是由于 II 类错误。
在手术室中，桡动脉和尺动脉损伤更常通过恢复血流而不是结扎来处理。年龄较大、钝性机制和同侧桡动脉和尺动脉损伤与主要截肢有关。总体截肢率为 3%，手部或更靠近近端水平的截肢率为 0.6%。上肢骨折、上肢神经损伤和同侧桡动脉和尺动脉损伤与需要进行修正手术有关。
