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

Management of Associated Injuries

United States Department of Defense

Unstable fractures can compromise vascular repairs. Bone length should be regained and fractures should be rapidly realigned and stabilized prior to vascular repair. Internal fixation is contraindicated, because of the risks of infection. External stabilization by skeletal traction or rapidly applied external fixation devices should be utilized. Dislocations, which result in ischemia due to distortion or compression of the associated artery, should be reduced immediately.

Concomitant nerve injuries which may occur in association with any vascular injury are more common in the upper than in the lower extremity. Repair of nerve injuries is generally not recommended in the combat zone. If nerve ends can be found expeditiously, they should be tagged with a nonresorbable suture for delayed elective repair.

Injuries to major veins should be repaired whenever possible. This is particularly true of injuries of the iliac, common femoral, superficial femoral, and popliteal veins. Occlusion of these veins frequently results in significant edema and late sequelae similar to the post-phlebitic syndrome In some instances, simple closure techniques such as lateral repair may be possible In others, more complex repairs using panel or spiral vein grafts may be needed. In such instances, the greater saphenous vein from the opposite, rather than the ipsilateral, extremity should be used. Preservation of the ipsilateral greater saphenous vein preserves an important source of venous outflow, should the venous repair fail.

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Operational Medicine 2001

Health Care in Military Settings

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