Radial or ulnar artery laceration. Repair or ligate?
M. Johnson, M. Ford and K. Johansen
Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle.
OBJECTIVE: To determine the relationship between patency of radial or ulnar
artery repair and later hand symptoms. DESIGN: Call-back survey. SETTING:
Urban trauma center. PATIENTS: Thirty-two subjects with wrist artery
lacerations undergoing 26 arterial repairs and six artery ligations during
an 8-year period. INTERVENTIONS: Directed history and hand examination
(palpation of wrist pulses, Doppler Allen test, and Doppler interrogation
of palmar arch and digital vessels). MAIN OUTCOME MEASURES: History of hand
claudication, weakness, or cold sensitivity or paresthesias and patency of
wrist arteries. RESULTS: Twelve (46%) of 26 wrist artery repairs were
patent. There was no evident benefit of optical magnification or
specialization in hand or vascular surgery. No subjects had hand
claudication; there was a 50% incidence of hand weakness and a 12%
incidence of cold sensitivity independent of patency of the damaged wrist
artery and present only in subjects with associated nerve injury.
Professional charges for wrist artery repair were threefold to fourfold
higher than those for wrist artery ligation. CONCLUSION: Consonant with
prior reports, patency following repair of radial or ulnar artery
laceration does not exceed 50%. Later hand symptoms relate to nerve or
tendon damage, not to arterial patency. In the absence of acute hand
ischemia, simple ligation of a lacerated radial or ulnar artery is safe and
cost-effective.
