Vascular injuries of the upper extremity

Vascular injuries of the upper extremity represent approximately 30% to 50% of all peripheral vascular injuries. The majority of injuries are to the b rachial artery, and 90% of injuries are due to penetrating trauma. Return o f function is often related to concomitant injury to peripheral nerves. How ever, timely restoration of blood flow is essential to optimize outcome, Th e diagnosis is made by physical examination and limited Doppler ultrasonogr aphy. Arteriography may be helpful if there are multiple sites of injury. A nticoagulation with heparin should be given if not otherwise contraindicate d, Revascularization should be completed within the:critical ischemic time: 4 hours for proximat injuries and 12 hours for distal injuries. Revasculat ion methods include resection and primary repair or resection with an inter position graft, The sequence of repair of multiple injuries to the extremit y begins with arterial revascularization followed by skeletal stabilization and nerve and tendon repair.