Histopathological evaluation of the arterial wall damage in upper limb injuries

Background: This study aims to evaluate the upper limb crush injuries according to the histopathological changes in the arterial vessel and to report the early and late clinical outcomes. Methods: We retrospectively analyzed of prospectively collected data of 12 patients (9 males, 3 females; mean age 33.3 +/- 11.7 years; range 18 to 57 years) with an upper extremity crush injury between February 2011 and November 2013. All the patients had a Mangled Extremity Severity Score of >= 7 and all had strong signs of vascular injury. Vascular reconstruction was performed after orthopedic stabilization. Digital subtraction angiography was routinely performed after hemodynamic stabilization. During the revascularization procedure, injured arterial vessels were harvested and stored in the formalin solution. The presence of endothelial swelling, intimal thickening, cellular vacuolization in the muscle layer, edema in the tunica media, and extent of the necrosis were evaluated. Results: Injuries were due to work-related accidents in five patients and motor vehicle accidents in seven patients. Vein graft interposition was performed in all patients (12; 100%). Primary patency rate was 75% and one patient died (30-day mortality 8.3%). Three amputations were performed 12 patients. The median follow-up was 3.2 (range: 2.1 to 3.7) years. Microscopic examination of the specimens collected revealed vascular congestion and thrombus formation, progressive subintimal dissection, and rupture of the membrane of elastic interna. Conclusion: Our study results suggest performing limb salvage procedures, even if the Mangled Extremity Severity Scores indicate amputation.