Ulnar Artery Injury Leads to Nerve Damage: A Surgical Oversight

Case Overview

This case involves an adult individual who sustained an injury to their ulnar artery from a pneumatic chisel. Upon arrival at the emergency department, the patient was evaluated by a general/trauma surgeon who explored the laceration and found no osseous or joint defects. Following a consultation with orthopedic surgery, it was determined that there was no bone damage. The trauma surgeon proceeded to ligate the artery using two 2-0 silk sutures. After removing the tourniquet, the surgeon noted proximal bleeding and repaired the resulting tear with a third 2-0 silk suture, achieving hemostasis.

Over the next two days, the patient reported decreased sensation in the middle and ring fingers, as well as diminished motor capacity in the hand. Approximately 24 hours later, the surgeon performed exploratory surgery and discovered that all three sutures had unintentionally ligated the ulnar nerve.

Questions to the Critical Care Medicine expert and their responses

How often do you repair arteries of the wrist and hand?

I am board certified in surgical critical care as well as general surgery and have been in practice for 19 years. I also serve as the trauma medical director of the busiest trauma center in Manhattan and am extensively familiar with the peer review and quality review process. If this patient were to present to our institution the hand surgery service would most definitely be called to manage this injury, particularly since the patient sounded like they were hemodynamically stable at the time of presentation.

What type of sutures should be used with an ulnar artery injury?

A 2-0 suture to ligate the radial artery is large and I wouldn’t consider using this large of a suture.

About the expert

This expert has over a decade of experience in the field of surgical critical care. He earned his BS in chemical engineering from Texas A&M and went on to earn his MD at Saint George's University. He then completed a surgical residency at Saint Barnabas Medical Center and fellowships in surgical critical care and trauma at the University of Southern California. He is board-certified in surgery and surgical critical care and is a member of several professional organizations including the American Society of Critical Care Medicine, the American Association for the Surgery of Trauma, and the Association for Academic Surgery. He has formerly served as an assistant professor and attending surgeon at Cedars Sinai Medical Center as well as an associate professor of surgery at Florida International University. He was also an attending surgeon and the trauma research director at Delray Medical Center. Currently, he serves as an attending acute care surgeon and the trauma medical director at a prominent hospital as well as an associate professor of surgery for a top medical school, both located in New York.

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Specialties:

Critical Care Medicine

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.