Combat Forearm Arterial Injuries: A Case Series.

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Combat Medicine

Background:

• High-energy combat trauma frequently causes severe forearm injuries involving both radial and ulnar arteries.
• Extensive soft tissue loss and compromised collateral circulation are common challenges in these cases.

Purpose of the Study:

• To evaluate the effectiveness of surgical interventions for acute forearm arterial injuries resulting from combat trauma.
• To assess clinical outcomes and identify optimal treatment strategies for these complex injuries.

Main Methods:

• A retrospective case series review of 28 male patients with combat-related forearm arterial injuries.
• Surgical techniques included ligation, end-to-end anastomosis, and autologous vein grafting, with temporary shunting used selectively.
• Clinical outcomes and complication rates were meticulously assessed.

Main Results:

• Successful hand salvage was achieved in 26 out of 28 patients.
• Complications included one case of graft thrombosis leading to amputation and one mortality.
• Sixty percent of patients experienced favorable long-term outcomes.

Conclusions:

• Repairing at least one forearm artery is critical for successful limb salvage in dual arterial injuries.
• Autologous vein grafting is the recommended approach for combat trauma-related forearm arterial injuries.
• The Mangled Extremity Severity Score may not be a reliable predictor of amputation; temporary shunts can be beneficial with proper adjuncts.