Upper Extremity and Junctional Zone Injuries

The injuries to blood vessels in the thoracic outlet or junctional zone and the upper extremity present significant challenges to trauma and vascular surgeons. As with other vascular injuries, there is a spectrum of severity dependent on the mechanism of injury, anatomic location, temporal circumstances, and concomitant injuries. Vascular trauma in the upper limb may result in life-threatening hemorrhage and tissue ischemia, leading to ischemic neuropathy/plexopathy, ischemia-reperfusion injury, compartment syndromes, and muscular contracture. Associated injuries to the nerves, bones and soft tissues may also contribute to dysfunction. In some instances, amputation is the result, either in the acute setting or in the chronic phase. Injuries leading to loss of function or amputation can be devastating and life-altering events for the patient. The best chance of successful management lies in early clinical assessment, correct application of damage control principles, proper use of diagnostic technologies, and efficient judgment as to the optimal treatment strategy. Junctional trauma requires early proximal control to stop hemorrhage; at times, this may require control from within the chest. As in other areas of vascular trauma, the use of endovascular technologies is becoming ever-more feasible to stop hemorrhage and restore vessel perfusion. Military experience has shown that, with better prehospital and in-hospital protocols, death rates from isolated upper limb vascular injury can be effectively reduced, death rates from isolated upper limb vascular injury can be effectively reduced, emphasizing functional outcomes as better benchmarks of care.