Traumatic musculoskeletal changes in forearm and hand after emergency vascular anastomosis or ligation

Whether the best option for the emergency treatment of major forearm artery lesions is anastomosis or ligation is still debated in the literature. The choice may be influenced by the resulting long-term musculoskeletal changes relating to vessel patency and the surgical procedure used. Fifty-three patients who had undergone emergency surgery involving arterial microanastomoses for lesions affecting one or more major forearm arteries (with a preserved distal circulation) were reassessed in terms of anastomosis patency at the end of a long-term follow-up, using arterial plethysmography, eco-color Doppler, and magnetic resonance angiography. In a subset of 40 patients, changes in bone mineral density (BMD) and lean mass of the affected limb were compared with the contralateral healthy limb and correlated with vessel patency and severity of trauma, using peripheral quantitative computed tomography and dual X-ray absorptiometry. Functional performance was also tested with a dynamometer by means of the hand-grip test. At long-term reassessment, 75% of the microanastomosed vessels were patent. BMD showed significant impairments at and around the site of the lesion (Delta: -6%, P < 0.001) and distally thereto (Delta: -3%, P < 0.05), which correlated with vessel occlusion and trauma severity. The fracture risk consequently also increased. There was evidence of a significant loss of lean mass ( P < 0.01) and muscle strength in the affected limb, especially in cases of occlusion of a major vessel. Given the satisfactory outcome of the anastomotic procedures as opposed to the greater loss of bone mass, muscular mass, and strength in patients who had undergone arterial ligation, we suggest that anastomosis is always preferable to ligation, even in emergencies. Anastomosis enables overall limb function to be better preserved (both in the vicinity of the lesion and distally).