Problems in the management of battlefield vascular injuries

1. 1. Restoration of vascular continuity after arterial injury is now standard procedure in both military and civilian practice. Surgical technics initiated and proved during the Korean conflict have been refined over the years. Experience has clearly demonstrated that almost all vascular injuries can and should undergo primary repair with the anticipation of a high rate of success. 2. 2. During a six month period in 1968, 450 vascular injuries in American casualties were treated in Vietnam. There were seven deaths in this group, and in 8 per cent of the cases amputation of an extremity was the final result of treatment. 3. 3. Analysis of the clinical course of patients who died or underwent amputation after treatment gave evidence that certain pitfalls confront the vascular surgeon. Extensive soft tissue damage, major venous destruction, associated fractures, repeated operations, and inadequate soft tissue debridement can and have led to catastrophic results. Examples of these problem areas are presented and recommendations are made for their management.