Two months ago, 28-year-old electrician Xiaokang (pseudonym) suffered an "electrical burn" from accidental electrocution. Although he received an artificial blood vessel replacement, he recently experienced pain and numbness in his right upper limb, along with black gangrene on his right little finger. Upon visiting the Vascular Surgery Department at the Second Affiliated Hospital of Guangzhou Medical University, he learned that the artificial blood vessel implanted in his right upper limb two months prior had become completely blocked!Without immediate treatment, his right upper limb would suffer ischemic necrosis. However, both endovascular procedures and reimplantation of an artificial vessel carried risks of re-occlusion.
What could be done? The vascular surgery team at Guangzhou Medical University Second Affiliated Hospital took an unconventional approach, using an autologous saphenous vein graft to reconstruct vascular access and save his limb.
Xiaokang, an electrician, suffered an "electrical burn" two months prior due to accidental electrocution. An "electrical burn" refers to extensive damage to the human body—including skin, subcutaneous tissue, deep muscles, blood vessels, nerves, bones, joints, and internal organs—caused by the thermal, electrophysiological, and electrochemical effects of electrical current, as well as arcs and sparks.Although the skin wounds from electrical burns may appear small, the damage to deep subcutaneous tissues is extensive and irregular in depth. Superficial layers may appear normal while deeper tissues suffer ischemia and necrosis. Progressive multiple vascular embolisms and necrosis can occur, ultimately leading to disability or death.
Xiaokang was admitted to a local hospital where surgeons performed surgery. Postoperatively, he believed his right upper limb had been successfully preserved. Unexpectedly, his right arm gradually developed pain and numbness, and his right little finger began to ulcerate.
What exactly was happening?Xiaokang sought treatment at the Vascular Surgery Department of the Second Affiliated Hospital of Guangzhou Medical University. Color Doppler ultrasound revealed "postoperative thrombosis (complete occlusion) in the right axillary artery and brachial artery graft." It turned out that the occlusion of the artificial vessel had caused insufficient blood supply to Xiaokang's right upper limb, with the right little finger serving as the site of gangrene. Without urgent surgery, Xiaokang's right upper limb would face ischemic necrosis.
Professor Lin Shaomang, Director of the Vascular Surgery Department at Guangzhou Medical University Second Affiliated Hospital, and his team immediately convened multiple discussions to formulate Xiaokang's surgical plan.
The experts determined that endovascular treatment via the femoral artery approach would yield a low long-term patency rate, carry a high risk of reocclusion, and fail to assess the vascular changes resulting from his previous electrocautery injury.While artificial vascular grafting offered a simpler surgical approach, it carried disadvantages including poor infection resistance, high long-term embolism rates, and an increased risk of non-healing anastomotic sites with suture loosening after brachial artery connection. Additionally, the high cost of the procedure posed a significant challenge.
"Given his young age and excellent physical condition, we ultimately opted for autologous saphenous vein grafting to replace the occluded prosthesis and restore vascular access in his right upper limb."Chief Physician Zhang Zhihui explained that autologous veins offer convenient harvesting, high patency rates post-transplantation, strong infection resistance, and excellent tissue compatibility due to their caliber matching major limb vessels. They also provide a relatively low-cost solution, making them ideal for repairing major limb vascular defects. Post-surgery, Xiaokang's right upper limb blood flow was restored, and his little finger ulcer healed.