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post-graft harvesting. This procedure requires extensile exposure, attention to detail, and careful hemostasis. Postoperative wound appearance may be enhanced by appropriate drainage, careful hemostasis, and subcuticular closure of vein donor sites. Using Steri-strips for 6 to 12 weeks and having the patient use a sunscreen may minimize scar spread and disfigurement.

Adequate exposure helps minimize technical errors during anastomoses, and the microscopic portion of the procedure should be "easy." Failure to maintain the graft in the proper orientation when placing it is problematic, because twisting the graft more than 60 degrees will compromise patency rates (Fig. 24—8). The role of intussusception anastomoses or mechanical couplers has yet to be delineated in arterial reconstruction with vein grafts. When appraising the anastomosis, it is vital to have uncompromised flow, and if it is compromised, it must be redone.

Complications

With patent vein grafts, ulcerations should heal and symptoms should improve, but complete elimination of pain, cold intolerance, and neural dysfunction is uncommon. Improvement, not cure, is the expectation, and the patient should understand that before proceeding with the operation.

Suggested Readings

Adham MN, Seradge H. Treatment of thrombosed thumb artery aneurysm: a report of four cases. J Hand Surg 1997;22A:750-752.

Axe MJ, McClain EJ. Complete involvement of the ulnar nerve secondary to an ulnar artery aneurysm. A case report. Am J Sports Med 1986;14:178-180.

Duchateau J, Moermans JP. False aneurysm of the radial artery. J Hand Surg 1985; 10A:140-141.

Gelberman RH, Blasingame JP. The timed Allen test. J Trauma 1981;21:477-479.

Gelberman RH, Blasingame JP, Fronek A, Dimick MP. Forearm arterial injuries. J Hand Surg 1979;4:401-408.

Ho PK, Weiland AJ, McClinton MA, Wilgis EF. Aneurysms of the upper extremity. J Hand Surg 1987;12A:39-46.

Murphy RX Jr, Korngold JM, Jaffe JW, Scarlato M. Bilateral radial artery pseudo-aneurysms associated with bilateral ulnar artery atresia: a case report. J Hand Surg 2000;25A:565-570.

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