Table 1

Evidence found from this review supporting coverage requirements of individual anatomical structures within the arm or axilla by ballistic protection

Anatomical structureDeath before 60 minSignificant long-term morbidityComments
Axillary artery and veinYesYesAlthough only damaged in 2% of penetrating injuries, these vessels are responsible for significant mortality.17 Bleeding from axillary vessels necessitates access to the subclavian artery to gain proximal control24
Brachial arteryYesYesDamage to individual vessels distal to the brachial artery can usually be ligated without morbidity.18 19 Primary repair of penetrating brachial artery injuries is only possible in one-third of patients.18 Prolonged ischaemia can cause distal necrosis resulting in nerve damage, muscle contracture and atrophy31
Median nerveNoYesOutcomes of median nerve repairs from projectile penetration injuries worse the more proximal the damage is with success only occurring in 10% of proximal repairs30
Ulnar nerveNoYesMost common nerve injury.25 31 Outcomes of ulnar nerve repairs from penetration injuries worse the more proximal the damage is with high-level ulnar nerve repair stated to be almost useless32
Radial nerveNoYesResponsible for the most disability of the three peripheral nerves following trauma.31 Outcome from proximal repairs is poor33