TY - JOUR T1 - Beware the circular saw JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000704 VL - 6 IS - 1 SP - e000704 AU - David J Skarupa AU - David V Feliciano Y1 - 2021/03/01 UR - http://tsaco.bmj.com/content/6/1/e000704.abstract N2 - While a young right-hand dominant man was working on a job site with power tools, a circular saw cut his left distal volar forearm. A pressure dressing was applied, and he was transported to the trauma center. The patient reported a significant amount of blood loss at the scene.The patient was awake and alert, and his primary survey was intact. On exposure, he had a transverse laceration to his distal left volar forearm that extended from the radial to ulnar side (figure 1). No bleeding was seen at the site of injury, but pulses were absent. Pulse oximetry of the fingers was decreased on the left (92%), as compared with the right hand (100%).Figure 1 Appearance of injury to the volar left forearm.What would be your next step in management?Explore wound at bedside.Close skin and follow-up as outpatient.CT arteriogram left upper extremity.Explore wound in the operating room.The patient was taken to the operating room without further diagnostic imaging. Based on the extent and location of the injury, as well as the findings on physical examination, the patient was presumed to have at least one, and, possibly, two arterial injuries at the wrist (radial and ulnar arteries).The entire left upper extremity and both lower extremities were prepared and draped in a sterile fashion. The incision was extended proximally and distally, along a standard volar forearm ā€˜Sā€™ incision for full exploration. The radial ā€¦ ER -