# Collateral circulation in a patient with combined traumatic radial and ulnar artery injuries

## TL;DR

A patient with severe hand artery injuries avoided amputation thanks to natural blood flow pathways, highlighting the importance of quick treatment.

## Contribution

This case highlights the role of collateral circulation in salvaging limb function despite major arterial injuries.

## Key findings

- The patient's hand was salvageable due to collateral arterial pathways despite arterial injuries.
- Delayed radial-radial artery bypass improved neuromotor function.
- Forearm vascular anatomy variability is critical in managing arterial injuries.

## Abstract

Combined radial and ulnar artery injuries are associated with a >35% amputation rate when not revascularized promptly. We describe a patient who suffered a penetrating injury to both the radial and ulnar arteries. Despite the ulnar artery being ligated and the radial artery primary repair becoming occluded after the index operation, his hand remained salvageable, likely because of collateral arterial pathways. The patient obtained a delayed radial-radial artery bypass and afterward achieved meaningful neuromotor function. This case emphasizes the importance of forearm vascular anatomy variability and the need for prompt management of arterial injuries to reduce limb loss and disability.