RADIAL / ULNAR ARTERIES

- Recommendations: Selective (repair some but not all)
- Utility of temporary shunt: Low (high probability of shunt thrombosis)
- Method/Conduit: Ligation, primary repair, or interposition graft with reversed saphenous vein

Pearls

- The presence of an arterial doppler signal in the hand obviates the need for artery repair.
- Repair with saphenous vein in instances where the absence of an arterial signal persists.

Most often the hand has a dual arterial supply and therefore can tolerate ligation of either the radial or ulnar artery. As such, repair, or reconstruction of an injury at this level is rare. Perfusion to the hand should be assessed with Doppler before and after occlusion or ligation, and if the absence of a signal persists, reconstruction with reversed saphenous vein should be performed. Given the relatively small muscle mass of the hand and the degree of collateral circulation, ligation is most often tolerated understanding that if ischemia persists, evaluation and revascularization can be performed at a CONUS facility days or weeks later.

LOWER EXTREMITY