Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
If no complications supervene, the swelling subsides, and recovery may
be complete in six or eight weeks. If the extravasation is great and the
skin threatens to give way, or if the vitality of the limb is seriously
endangered, it is advisable to expose the injured vessel, and, after
clearing away the clots, to attempt to suture the rent in the artery,
or, if torn across, to join the ends after paring the bruised edges. If
this is impracticable, a ligature is applied above and below the
rupture. If gangrene ensues, amputation must be performed.
These descriptions apply to the larger arteries of the extremities. A
good illustration of subcutaneous rupture of the arteries of the head is
afforded by the tearing of the middle meningeal artery caused by the
application of blunt violence to the skull; and of the arteries of the
trunk--caused by the tearing of the renal artery in rupture of the
kidney.
#Open Wounds of Arteries--Laceration.#--Laceration of large arteries is
a common complication of machinery and railway accidents. The violence
being usually of a tearing, twisting, or crushing nature, such injuries
are seldom associated with much hæmorrhage, as torn or crushed vessels
quickly become occluded by contraction and retraction of their coats and
by the formation of a clot. A whole limb even may be avulsed from the
body with comparatively little loss of blood. The risk in such cases is
secondary hæmorrhage resulting from pyogenic infection.
The _treatment_ is that applicable to all wounds, with, in addition, the
ligation of the lacerated vessels.
#Punctured wounds# of blood vessels may result from stabs, or they may
be accidentally inflicted in the course of an operation.
The division of the coats of the vessel being incomplete, the natural
hæmostasis that results from curling up of the intima and contraction of
the media, fails to take place, and bleeding goes on into the
surrounding tissues, and externally. If the sheath of the vessel is not
widely damaged, the gradually increasing tension of the extravasated
blood retained within it may ultimately arrest the hæmorrhage. A clot
then forms between the lips of the wound in the vessel wall and projects
for a short distance into the lumen, without, however, materially
interfering with the flow through the vessel. The organisation of this
clot results in the healing of the wound in the vessel wall.
In other cases the blood escapes beyond the sheath and collects in the
surrounding tissues, and a traumatic aneurysm results. Secondary
hæmorrhage may occur if the wound becomes infected.
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