Traumatic brachial artery reconstruction using an in-wound no-touch superficial vein graft with 20-month imaging follow-up: a case report.

Authors

Heng Tian, Yang Liu, Rui Li

Published in

BMC surgery. Jun 30, 2026. Epub Jun 30, 2026.

Abstract

Autologous vein grafting is commonly used for traumatic limb arterial defects when tension-free primary repair is not possible. The no-touch harvest technique has shown structural and patency advantages in coronary surgery, but its role in traumatic upper-extremity reconstruction remains uncertain.
A 63-year-old man sustained an open right elbow injury caused by a fan blade, with brachial artery transection, superficial venous injury, lateral antebrachial cutaneous nerve injury, and superficial brachioradialis laceration. After microscopic debridement, the arterial defect between viable ends measured about 5.5 cm. A median cubital vein within the wound was selected as an interposition conduit because an adequate segment remained outside the most severely damaged zone, the wall appeared continuous without visible thrombosis or crush injury, and the caliber matched the brachial artery. The vein was harvested with a limited cuff of surrounding tissue using a no-touch concept, reversed, and anastomosed end-to-end under the microscope. The patient received intraoperative heparin and short-term postoperative low-molecular-weight heparin, but no long-term oral antithrombotic therapy because of individualized bleeding-risk and wound considerations. At 20 months, duplex ultrasonography and computed tomography angiography showed sustained graft patency, preserved distal runoff, and mild ectatic change without hemodynamically significant stenosis, occlusion, or pseudoaneurysm.
This case supports technical feasibility rather than superiority in selected traumatic brachial artery injuries. An in-wound superficial vein may be usable when a structurally intact segment remains available outside the most severely injured zone. The no-touch concept was technically applicable in this setting, but its clinical benefit in peripheral trauma remains unproven.

PMID:
42374309
Bibliographic data and abstract were imported from PubMed on 30 Jun 2026.

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