ABSTRACT
Injuries to the blood vessels in the extremities continue to present signicant challenges to surgeons. As with other vascular injuries, there is a severity spectrum depending upon mechanism, anatomic location, temporal circumstances, care available and concomitant injuries. Laceration, complete and partial transection, contusion with or without secondary wall/intimal defect, secondary aneurysm, pseudoaneurysm, arteriovenous stula, tapered lesions and external compression in the perivascular space may all be at play from blunt, penetrating, blast or combined mechanism. How to manage each particular incident of extremity vascular injury can be quite dierent depending on these features. As the spectrum noted earlier evolves, repair and management become more complicated. Life-threatening hemorrhage may occur. Tissue ischemia, particularly as it is prolonged, may lead to ischemic neuropathy/plexopathy, compartment syndromes and muscular contracture or necrosis. Associated direct injuries to the nerves, bones and so tissues may also contribute to pain and dysfunction and ultimately dictate the fate of the limb. Eorts pursuing limb salvage in order to restore vascular integrity and neuromuscular function may fail. In some instances, secondary amputation aer salvage attempt is required either in the acute
setting or in the chronic phase aer injury. Furthermore, primary amputation as initial treatment is a consideration in instances where salvage will provide less functionality than amputation, or where the physiologic insult will be poorly tolerated and might be life-threatening. Heroic eorts focused on reconstruction, and limb salvage alone does not necessarily provide superior quality of life for all patients.
