Surgical Management of Arterial Injuries Within the Forearm: A Systematic Review

Traumatic injuries to the forearm often involve damage to the radial or ulnar arteries. In isolated single vessel injuries whereby the hand remains perfused, the surgeon is presented with a dilemma: to repair or ligate? This systematic review aims to compare the outcomes between patients who underwent surgical repair or ligation of vessels (PROSPERO: CRD42022311323). A systematic electronic search of Medline, Embase, CINAHL, PubMed, and Cochrane CENTRAL databases was conducted (March 11, 2022). All surgical comparative studies in adults sustaining a single forearm vessel injury with a minimum follow-up period of 12 months were included, evaluated using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) and Critical Appraisal Skills Programme (CASP) tools. Three studies, totalling 80 patients, were included. Pooled long-term patency was 76% (48/63) across both radial and ulnar arterial repair. One study reported that ligated vessels showed a significant reduction in bone mineral density. Another study reported a significantly reduced lean muscle mass (p < 0.01) and strength following ligation. One study reported no difference in pain and cold intolerance between the ulnar artery ligation and repair groups. There is limited high-quality evidence available and significant heterogeneity within the reported outcomes. Our review suggests that repairing single vessel injuries is associated with improved outcomes; however, further high-quality studies on the topic are needed.