A case of traumatic hand ischemia – Managed successfully with neurovascular and soft-tissue reconstruction

Abstract

Upper limb has rich vascular supply due to sufficient collaterals around the shoulder, elbow, and wrist joints which prevents ischemia and maintains viability of the upper limb in case of vascular injury or occlusion. There are numerous literature available, regarding the management of isolated single arterial injury in the forearm, which suggest that ligation of single artery (radial or ulnar) is safer if the companion arterial supply is intact. Hand salvage becomes more challenging when patient presents with acute hand ischemia following injury to both forearm arteries and has associated musculoskeletal injuries. We hereby report the case of a 24-year-old male who sustained glass-cut injuries to his right distal forearm resulting in both forearm arterial, nerves, flexor tendon injuries, and presented as acute hand ischemia. The patient was managed by reconstruction of radial and ulnar arteries using reverse saphenous vein graft (RSVG) along-with primary repair of median and ulnar nerves and flexor tendons. Skin and soft tissue defect was subsequently covered using antero-lateral thigh flap. The prompt and timely management of patient resulted in hand salvage with good functional outcome.

Keywords

• antero-lateral thigh flap
• arterial reconstruction
• reverse saphenous vein graft
• traumatic hand ischemia