Arterial Injury in the Upper Limb Resulting from Dog Bite

Oliver Vincent Cawley, Anna S Walsh, Imran Asghar, Hans U Desmarowitz, George A Antoniou
Annals of Vascular Surgery 2018, 49: 314.e5-314.e10
Dog bites in the upper limbs have particular significance, because despite the small size of the puncture wounds, penetration is deep, causing serious injuries to deeper structures. There is currently very little data relating to upper extremity dog bite arterial injury. We present the case of a 32-year-old man who sustained a dog bite injury to his right arm, leading to direct puncture and spasm of the brachial artery. He was successfully treated with a jump bypass graft to the right brachial artery, with the use of the reversed ipsilateral cephalic vein as a conduit. We identified 34 cases in the literature reporting upper limb arterial injury secondary to dog bite. Twenty-two cases in the literature detailed axillobrachial artery damage (65%), 24% radial artery, 3% ulnar artery, and 9% combined. Presentation was most commonly with diminished pulses found in at least 45% of the patients. Arterial thrombosis occurred in 29% of cases of single artery injury, transection in 15%, intimal tear in 9% of cases, and undisclosed in 44%. Management most commonly included interposition graft (47%) and primary repair (20%), while 15% did not undergo surgical intervention, 9% underwent ligation, and 3% were treated with thromboembolectomy. Follow-up data for these patients are scarce, with some experiencing residual neurological deficit. This report highlights the importance of prompt recognition and treatment of vascular injury following dog bite to attain an optimal outcome and minimize complications.

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