Vascular injuries of the limbs

Seven different kinds of arterial injury may occur to the limb. These may be accompanied by external bleeding and may result in ischemia sufficient to put the limb in jeopardy. There may be contusion of the arterial wall and thrombosis. There may be true or false aneurysms and arteriovenous fistulas. The extent and location of the injury must be ascertained early. The artery should be conservatively debrided and repaired by end-to-end anastomosis, interpositional grafting or bypass grafting. When possible, skeletal injuries should be stabilized by external fixation. Nerve injuries should be marked for later repair. Antibiotics should be used prophylactically. Mannitol may be used for diuresis. Amputation may be indicated. Fasciotomy is carried out in the presence of compartment compression.