Penetrating wounds of the extremities. Methods of identifying arterial injury

Controversy surrounds the optimal management of a wound in proximity to a major vascular structure without clinical evidence of arterial injury. Current data suggest that physical examination alone can detect significant arterial injuries. If an arterial lesion is clinically silent on initial presentation, the natural history is most likely benign. In the rare case in which the arterial lesion degenerates into a more significant lesion, then it will do so slowly and can be repaired electively. In certain instances, there may be a penetrating wound that presents with a pulse deficit that resolves completely with observation. At this time, this is considered a hard sign of vascular injury and warrants aggressive preoperative evaluation.