Axillary and Brachial Injuries

Abstract

Improved imaging modalities and surgical techniques have dramatically changed the management of upper extremity vascular trauma, with a concomitant rise in limb salvage rate over the past 80 years. Surgical management of upper extremity vascular trauma is complex due to the close relationship between the arteries, veins, and nerves along with challenges involved in attaining appropriate surgical exposure. A close familiarity with the anatomy in conjunction with high-quality diagnostic imaging is vital for appropriate surgical planning. Due to the complexities involved in achieving open access to some of the more proximal vessels, endovascular management is gaining popularity. The use of stent grafts to repair damaged vessels may avoid the morbidity associated with median sternotomy with cervical extension and the extended dissection that is involved. Even in the presence of “hard signs” of vascular injury, endovascular techniques may facilitate damage control surgery and achieve hemostasis until a more definitive procedure can be completed. Proper coordination with trauma, orthopedic, and vascular surgery is necessary to minimize ischemia, properly debride nonviable tissue, and repair all of the involved injuries. Decompressive fasciotomy, even if prophylactic in nature, is an important component of avoiding the morbidity and mortality associated with compartment syndrome.