title: Brachial artery injuries in a rural catchment trauma center: are the upper and lower extremity the same?
abstract: BACKGROUND
  The predictors of amputation for patients with lower extremity vascular trauma are well described in the literature, but the predictors of amputation in the upper extremity are not so well defined. We hypothesize that the predictors of amputation in the lower extremity are much different when compared with the upper extremity.
  
  
  METHODS
  Retrospective chart review of all brachial artery traumatic injuries presenting to a rural-state university trauma center.
  
  
  RESULTS
  In a 6-year period, 41 patients presented with brachial artery injuries. Operative management was performed in 38 (93%) patients which included 23 reversed saphenous vein grafts, 13 primary repairs, and 2 synthetic grafts. There were four deaths (9.8%) and four (9.8%) amputations. Comparing the amputation and limb salvage groups, the Injury Severity Score (ISS) was 32 versus 12, whereas the Mangled Extremity Severity Score (MESS) was 7 versus 4.3. Five patients had a MESS score greater than 7; four of whom had an amputation or died. Amputation was performed in only 4 of 23 patients with neurologic deficits. Limb salvage was successful in 24 of 28 patients without a palpable pulse on arrival.
  
  
  CONCLUSIONS
  Predictors of amputation in brachial artery injuries differ from lower extremity vascular injuries. Delayed presentation greater than 6 hours, MESS, open fracture, nerve deficits, and diminished capillary refill were not predictive of amputation for patients with brachial artery injuries. These data suggest that the vast majority of upper extremity injuries should have attempted salvage regardless of the severity scoring systems.
authors.affiliation: Department of General Surgery, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA. jdsimmons@surgery.umsmed.edu
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmieg
authors.forename: John M
authors.initials: JM
authors.lastname: Porter
authors.forename: Sean E
authors.initials: SE
authors.lastname: D'Souza
authors.forename: Juan C
authors.initials: JC
authors.lastname: Duchesne
authors.forename: Marc E
authors.initials: ME
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001132:Arm / Q000601:surgery*; D001916:Brachial Artery / Q000293:injuries*; D002391:Catchment Area, Health; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008922:Mississippi; D015424:Reperfusion; D012189:Retrospective Studies; D019035:Rural Health Services; D013997:Time Factors; D014193:Trauma Centers