Early vascular grafting to prevent upper extremity necrosis after electrical burns: Anastomotic false aneurysm, a severe complication

Abstract

From May 1972 to January 1982, early vascular grafting was used to re-establish circulation across the electrically burned wrist. Thirty-three thrombosed arterial segments (radial and/or ulnar arteries) were removed in 18 limbs and autografts of the greater saphenous or omental veins were used for the revascularization. One vascular graft, which had been sutured to the ulnar artery on day 3 post-injury, contained an anastomotic false aneurysm at the proximal anastomosis. One month after vascular grafting, this aneurysm ruptured and bled. An emergency exploration of the wrist confirmed the diagnosis and surgery successfully restored the circulation, avoiding amputation of the injured limb. Histopathological examination of the specimen was consistent with the presence of anastomotic false aneurysm. The pathogenesis of this complication is reviewed. Our experience indicates that circulation to a limb following electrical injury can be successfully restored by early vascular grafting, but emphasizes the importance of close periodical follow-up after graft acceptance due to the possibility of late anastomotic complications.