Vascular Injuries Op the Extremities in Battle Casualties

Vascular Surgery in World War II

“…17 Other published accounts reflect a similar reliance on ligation. [18][19][20] Few arterial repairs took place: the Third Army repaired only 16 of 362 vascular injuries (4.4%), 10 of which failed and required amputation. 17,21,22 DeBakey and Simone identified only 81 instances of repair in 2471 cases, or a 3.3% repair rate; only 3 were end-to-end anastomosis and none were venous autografts; the rest were lateral suture of minor wounds.…”

“…It featured prominently in pre-World War II instructions for American surgeons, who practiced the technique extensively in the early years of the conflict. 19,[22][23][24] However, by late 1944, data did not reveal any benefit to the procedure, and an Inter-Allied Conference in December formally recommended its discontinuance, though many surgeons continued the practice. 25,26 Established in the 1930s, chemical and surgical sympathectomies promised to revolutionize vascular surgery by dilating arteries.…”

“…Other surgeons reported similarly dismal experience with ligation and similarly positive results when attempting repairs. [18][19][20] By 1945, surgeons well understood the consequences of ligation and were willing to attempt something new and experimental, doubting the outcomes could be worse. One Evacuation Hospital in Europe, for example, ''distressed'' over the high amputation rates after ligation, transitioned from tying off 100% of their damaged arteries in 1944 to repairing 14% in 1945, a percentage that jumps to 23% if you discount wounds to the tibial vessels that surgeons rarely repaired; either rate far exceeded the 3.3% that DeBakey and Simeone quoted.…”

War Experiences With the Nonsuture Technic of Anastomosis in Primary Arterial Injuries

“…Local thrombosis frequently follows the repair. 27 Besides these initial factors, suture is dangerous in a war wound which is left open, as hemorrhage is apt to occur. Infection is still too often present, and, finally, there may be little or no support of the vessel by healthy adjacent tissues.…”

Arterial Advances of Orthopædic Concern

“…With any vessel ligature, arteriographv shows that the blood seeks to find its wav into the main deeper channels; unless that flow is maintained, fairlv briskly, thrombosis ensues. I need only quote the latest paper of 100 major vessel injuries in wvar by Rose, Hess and Welch [2]. Their liml) mortalitv, despite rouitine sympathetic blocks, is high, and I quote their blunt comment "in no case did this procedure appear to reverse the progress from an avascular state in patients with severed arteries."…”