Evidence-based Comprehensive Approach to Forearm Arterial Laceration

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Hand Surgery

Background:

• Penetrating forearm injuries can involve arteries, veins, nerves, and tendons.
• Management strategies for forearm arterial injuries vary, with ongoing debate in urban trauma centers.
• No evidence-based guidelines currently exist for managing forearm arterial lacerations.

Purpose of the Study:

• To provide a systematic, evidence-based approach to managing forearm lacerations with arterial injury.
• To review operative and nonoperative strategies for isolated and complex forearm injuries.

Main Methods:

• A comprehensive literature search was conducted using MedLine, Cochrane Library, Embase, and the National Guideline Clearinghouse.
• The review focused on identifying evidence-based management guidelines and consensus statements.

Main Results:

• Routine emergent exploration of forearm lacerations is generally not warranted or cost-beneficial.
• Conservative hemostasis methods (digital pressure, tourniquets, dressings) are effective for most forearm arterial injuries.
• Arterial, nerve, or tendon injuries in the forearm do not typically require immediate surgical repair if the hand remains well-perfused.

Conclusions:

• Optimal hemostasis can be achieved through a combination of conservative measures.
• Surgical intervention is reserved for critical ischemia requiring expedited arterial perfusion restoration.
• Early hand specialist consultation and delayed primary repair for complex injuries are recommended to maximize functional outcomes.