Influence of the level of arterial resection on the replanting and revascularization results in hand surgery: prospective study over 22 months

The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results. L’objectif de ce travail était d’évaluer si les mécanismes lésionnels peuvent être responsables de lésions histologiques artérielles. Cette étude prospective monocentrique a inclus des patients majeurs présentant une lésion artérielle de la main et du poignet. Une recoupe artérielle de minimum 2 mm des moignons proximaux et distaux était réalisée avant l’anastomose artérielle. Une analyse histologique des moignons artériels était réalisée. Une échographie artérielle de contrôle de perméabilité était réalisée à 1 mois postopératoire. Une réévaluation clinique et fonctionnelle était réalisée à 1 mois puis tous les 3 mois. De 2018 à 2020, 46 patients ont été inclus avec un recul maximal de 13 mois avec 35 sections, 2 écrasements, 8 amputations et 1 blast. Macroscopiquement, 37% des berges étaient consid