Limb Salvage After Grenade-Related Brachial Artery Injury: A Case Report

Since war injuries are not predictable, each patient presents as a new and unique case. Before deciding on amputation for upper extremity injuries, it is necessary to evaluate all limb-sparing vascular interventions that will keep the amputation level as distal as possible, in order to improve the patient's quality of life and enable the use of more functional prostheses. While amputation may be a faster and more life-saving option for a surgeon, limb-sparing and mobile joint-preserving surgical procedures should be the preferred choice, provided the patient's overall condition permits. This case report presents a 23-year-old male soldier who sustained a hand grenade blast injury resulting in traumatic partial amputation of the right hand, fractures of the right ulna, radius, and humeral diaphysis, and a segmental brachial artery injury with extensive soft-tissue loss. The interval from injury to arrival at the definitive (Role 4) treatment facility was approximately 8 hours, and the patient underwent operative revascularization within 30 minutes of admission. After embolectomy failed to restore adequate arterial backflow, an 18-cm autologous saphenous vein graft was interposed between the axillary and distal brachial arteries, restoring distal perfusion and allowing the amputation to be maintained at the below-elbow level rather than above the elbow. Doppler ultrasonography confirmed sustained graft patency through 12 months of follow-up, and the patient was successfully fitted with a below-elbow prosthesis at 7 months, achieving satisfactory functional adaptation.