Contributions of the surgeon Nikolai Korotkov (1874-1920) to the management of extremity vascular injury.

Abstract

The Russian military surgeon Nikolai Korotkov is known worldwide, mainly among internists and cardiovascular specialists, as the discoverer of the auscultatory method of measuring arterial blood pressure in 1905. This article reveals him as one of the first military vascular surgeons to carefully investigate, analyze, and register cases of vascular injury during his voluntarily trips to the Russian Far East in 1900 to 1901 and the Russo-Japanese War of 1904 to 1905. Examining 44 patients with extremity arterial and arterial-venous pseudoaneurysms following war-related injury, he routinely performed a measure termed the "arterial pressure index" using "Korotkov sounds." This pioneering approach to assessing extremity perfusion was the precursor to the modern-day ankle-brachial and injured extremity indices, and it initiated the quantitative assessment of the compensatory ability of the vascular system to restore circulation following axial artery ligation. Because of high thrombosis rates following direct vessel repair during his day, he proposed use of pharmacologic substances such as digitalis and amyl nitrite to improve extremity perfusion. As evidence of his innovative nature, Korotkov even proposed the use of "oxygenated nutrient solutions" in the future to improve extremity circulation. More than 100 years after his work, as continuous wave Doppler ultrasound, contrast angiography, and computed tomography are ubiquitous as diagnostic tools, the practice of surgery would be well served to recall Korotkov's foundational work and the rule of thumb for any physician: examine the patient.