Acute arterial injuries in civilian practice

Abstract

LTHOUGH primary repair of an acute arteria1 A injury was performed nearly 200 years ago by Lambert and HaIIeweII [I], only in the Iast decade has this technic succeeded ligature as the accepted operative treatment. In a series of 2,471 acute arteria1 wounds incurred during WorId War II, suture repair was accompIished in only eighty-one cases, most of which were smaI1 IateraI Iacerations; in only three instances was end-to-end anastomosis performed [2]. ResuIts in these eighty-one cases, however, were considerably better than those of ligation, and for the first time it appeared that reparative technics were practicabIe in the treatment of acute arteria1 wounds incurred in combat. hJeanwhiIe, rapid deveIopments in cardiovascuIar surgica1 technics for the correction of certain congenital disorders (such as patent ductus arteriosus, tetraIogy of FaIIot and coarctation of the aorta) had demonstrated the value of arterial suture as an effective procedure, leading to its estabIishment as the method of choice in the reparative surgica1 treatment of acquired arteria1 disease [j-3]. In the Iight of these deveIopments the Korean conff ict provided favorable circumstances under which to demonstrate concIusiveIy the feasibiIity and eficacy of primary repair of acute vascular wounds. Among fifty-eight cases of arteria1 injuries treated in this manner, reported by Jahnke and Howard [6], amputation was performed in onIv six cases. Hughes [7] found an I I per cent incidence of amputation foIlowing repair of seventy-nine major arteria1 injuries. Spencer and Grewe [8] in ninety-seven arteria1 injuries, of which eighty-nine were repaired primariIy, reported twenty:one amputations. However, in their series InJury was so extensive as to require a graft in forty-seven cases. CiviIian practice shouId provide the most favorable circumstances for primary repair of arteria1 injuries. In generaI, the interval of time between injury and repair is much shorter than in miIitary practice. Moreover, most civiIian arteria1 injuries are simple stab wounds and Iacerations, and gunshot wounds are not as severe because civiIian firearms have a much Iower muzzIe veIocity. Hence massive destruction of soft tissue and associated injury to other parts are Iess IikeIy to compIicate the problem. For the purpose of evaIuating the results of primary repair in civiIian practice, an anaIysis was made of a11 patients with acute arteria1 injury admitted to the Baylor University affIIiated hospitaIs during the seven-year period ending JuIy 3 I, 1956. Most of these 136 patients had been treated at the Jefferson Davis HospitaI, a city-county genera1 hospital for the indigent, where large numbers of cases of trauma are seen annuaIIy. Most of the reparative procedures were performed by members of the resident staff. Incidence. As might be expecteci in an anaIysis of injuries incurred primarily through vioIence with knives and pistoIs, the ages of most patients were found to be in the third and fourth decades. Ages ranged from eight to sixty-two years (mean, thirty years), so that in onIy a few patients did arteriosclerosis produce technical probIems in repair. Ninetythree (68 per cent) of the patients were Negroes; 120 patients (88 per cent) were maIes. Interval between Injury and Treatment. The interva1 of time between initia1 injury and both emergency and definitive treatment was estimated in each case. An average of 1.2 hours elapsed from injury to institution of resuscitative measures, and 4.5 hours from injury to definitive surgica1 treatment. A few of the