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Operational Medicine 2001
Emergency War Surgery
Second United States Revision of The Emergency War Surgery NATO Handbook
United States Department of Defense

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Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries

Debridement and Evaluation of Patency

United States Department of Defense


After gaining control of the injured artery, rapid wound debridement is accomplished in the standard fashion. Excision of devitalized tissue should be complete, including any damaged artery. Debridement of the artery. itself should be as conservative as possible. Only grossly injured artery should be excised. Although microscopic changes have been found in the normal appearing artery adjacent to the obviously traumatized segment, there is no evidence that resection of normal appearing artery on either side of an injured segment is necessary.

Distal arterial patency may be evaluated before repair by careful passage of a balloon tipped catheter. One cannot be certain of distal arterial patency based on the presence of or the rate of back bleeding, as back bleeding simply indicates patency to the level of the first major collateral. Only operative arteriography or reestablishment of distal pulses after repair can be considered proof of distal arterial patency,

The possibility of additional arterial injuries, either close to or at some distance from the recognized injury, should be considered and demonstrated either by intraoperative arteriography, if practical, or by direct exploration. Failure to repair a second arterial injury usually leads to a poor result regardless of the adequacy of repair of the initially recognized injury.

 

 


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Operational Medicine 2001

Health Care in Military Settings

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001

United States Special Operations Command
7701 Tampa Point Blvd.
MacDill AFB, Florida
33621-5323

This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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