Exposed Brachial Artery Managed with Dermal Substitute as the Savior: A Case Report

Managing crush injuries of upper extremities with severe devitalization of surrounding tissues is often complicated by limited covering options. A 46-year-old male patient presented 4 days after sustaining a crush injury, for which he had undergone vascular repair at another hospital. The patient had extensive necrosis of forearm muscles, with uncertain vascularity of the hand. Debridement of the wound exposed the brachial artery; viability of the hand was still uncertain. Lacking healthy surrounding tissue for coverage, and also to minimize donor site morbidity in a limb with an uncertain prognosis, a dermal substitute was utilized to protect the exposed brachial artery. After the progressive necrosis had stabilized and the dermal substitute had successfully integrated, skin grafting was performed. The patient experienced an uneventful recovery and is now scheduled for functional restoration procedures in the near future. The dermal substitute was instrumental in managing this difficult situation.