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- W2159104702 abstract "The duration of limb ischaemia following blunt or penetrating vascular injury is one of several factors influencing the incidence of compar tment syndromes, ischaemic contracture, muscle necrosis and amputation. These wide-ranging effects of arterial injury, haemorrhage and ischaemia emphasise the importance of speed in restoring flow. Despite all the advances made in the managemen t of vascular injuries through the main conflicts in recent decades, a small but measurable incidence of complications including amputat ion continues, mainly as a consequence of the complexity of the injury and the time taken to evacuate the victim to hospital. The rationale and importance of shunting injured limb arteries and veins can best be judged firstly by a clear understanding of the pathophysiological effects of vascular disruption, and secondly by an appreciation of the constraints and shortcomings in the customary management of vessel injuries. The effects of major vascular disruption are aggravated by hypovolaemic shock and this scenario may be further complicated by associated bone and major soft tissue injury. The acute impairment of tissue perfusion and the corresponding fall in tissue pO2 increase capillary permeability and exudation of fluid into the interstitial space creating high compartmental pressures which in turn elevate venous pressure to cause further exudation. Swollen muscle fibres confined within inelastic fascial compar tments offer resistance to arterial inflow, already attenuated by several factors such as the vasoconstrictive response to hypovolaemia, haematoma, concomitant vein injury and soft tissue damage. Robbed of any residual-blood supply the extremity undergoes widespread small vessel thrombosis. 1" @default.
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- W2159104702 date "1989-01-01" @default.
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- W2159104702 title "The rationale for arterial and venous shunting in the management of limb vascular injuries" @default.
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- W2159104702 doi "https://doi.org/10.1016/s0950-821x(89)80120-3" @default.
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