MANAGEMENT OF SEVERE PROXIMAL VASCULAR AND NEURAL INJURY OF THE UPPEREXTREMITY

Purpose: Early amputation has been suggested to be the optimal treatme nt for severe combined vascular and neural injuries of the proximal up per extremity. This retrospec tive study was done to evaluate the long -term clinical outcome of our policy of limb salvage by revascularizat ion and delayed treatment of neural injuries. Methods: forty-six patie nts with neural and vascular trauma to the upper extremity were treate d at our institution. All of these patients had aggressive treatment d irected at limb salvage with restoration of vascular supply and nerve function. Long-term vascular and neurologic outcomes were recorded. Ne urologic deficits were validated by the American Medical Association's standardized disability impairment scale (0% to 100%). Results: The r ate of preoperative disability was 83%, which improved to 52% (p < 0.0 1) after treatment (mean follow-up, 43 months). Overall, 87% showed im provement. Conclusion: These results suggest that early amputation sho uld not be performed unless there is massive tissue loss or an attempt at limb salvage might endanger Life. final outcomes cannot be predict ed on the basis of initial clinical presentation. As a group, the majo rity of these patients improved with aggressive intervention. (J Vasc Surg 1998;27:43-9.).