When a major artery is cut or crushed, the tissue beyond it starts dying within hours. Restoring flow quickly is what decides whether a limb is saved, and it is one of the few things in surgery where the clock genuinely matters more than anything else.
Arterial injury repair restores blood flow to a limb after an artery has been cut, torn or blocked by injury. The damaged segment is exposed, clot removed, the injured ends trimmed back to healthy vessel, and the artery repaired directly or bridged with a vein graft. Ideally this happens within about six hours of injury, because muscle does not survive much longer without blood.
Muscle is the least tolerant tissue in the limb. Skin and bone survive long periods without blood, but muscle begins to die after about six hours, and once it does, restoring flow can release breakdown products into the circulation that damage the kidneys and heart. This is why arterial injury is treated as an emergency rather than as an operation that can wait until morning.
An injured artery is dealt with in a set order. Bleeding is controlled first, usually with direct pressure rather than blind clamping, which risks damaging the nerve alongside. The artery is then exposed above and below the injury, clot is cleared from both directions, and the damaged ends are cut back until healthy, bleeding vessel is reached.
What happens next depends on the gap. A clean division with no tissue loss can be sewn end to end. A gap, which is more usual after crush or blast injury, needs a bridge, and a piece of the patient's own vein taken from the other leg is the preferred material. Associated injuries to bone, nerve and vein are then addressed, and the fascial compartments are often released at the same time.
This is emergency surgery, so the question is rarely whether to operate but how much of the limb can be saved and whether repair or amputation gives the better outcome.
Direct pressure first. Blind clamping in a pool of blood damages the nerve that runs beside the artery.
The artery is controlled in healthy tissue on both sides of the injury before the damaged segment is opened.
A balloon catheter is passed up and down the vessel to remove clot that has formed beyond the injury.
Crushed artery wall will not hold a repair. The ends are cut back until the wall looks and bleeds normally.
A clean division is sewn directly. A gap is bridged with a reversed vein graft taken from the opposite leg.
The fascial compartments are usually released, because swelling after flow returns can itself cut off the circulation.
Bone is stabilised, nerve repaired or marked for later, and the repair covered with healthy tissue, often a flap.
Circulation is checked repeatedly. This is when re-thrombosis and compartment syndrome occur. Kidney function is monitored after long ischaemia.
Fasciotomy wounds are inspected and closed or grafted in stages. Dead muscle, if any, is removed. Physiotherapy begins early.
Wounds heal, splints maintain position, and the extent of nerve recovery starts to become apparent.
Nerve recovery continues for a year or more. Secondary procedures for stiffness, tendon transfer or scar release are planned once the limb has settled.
A successfully repaired artery restores circulation, and most limbs that regain flow within the first hours survive. Function is a separate question. Nerve injury sustained at the same time recovers slowly and often incompletely, muscle that died before flow was restored is replaced by scar, and stiffness and weakness are common. Some limbs that are technically salvaged remain less useful than a well fitted prosthesis, and that difficult conversation is had honestly rather than avoided. Further operations are common.
These are serious injuries and the risks reflect that. They are discussed with the family where the patient cannot consent.
The first 48 hours after restoring flow need close observation, because that is when compartment syndrome and re-thrombosis occur.
A limb can look reasonable early on, supplied by smaller collateral vessels, while the main artery is divided. Pulses and Doppler assessment matter more than colour.
Direct pressure controls most bleeding and causes less damage. A tourniquet has a place in catastrophic haemorrhage but, applied unnecessarily or left too long, it can cost the limb.
Restoring flow saves the tissue. Function depends on the nerves and muscle, and recovery takes months with further operations often needed.
Arterial trauma needs a surgeon who can repair the vessel, cover the wound and manage the nerve, at whatever hour the injury arrives. Microsurgical capability and emergency theatre access are what make limb salvage possible rather than theoretical.
Emergency vascular trauma is covered by health insurance and by government schemes including PM JAY in most circumstances. Cost depends on the length of admission, the number of operations required and whether intensive care is needed. Treatment is never delayed for a financial discussion; the paperwork follows.
These are almost always asked by relatives in the first hours.
Ask your question →Roughly six hours of warm ischaemia is the figure usually quoted, because that is when muscle starts to die irreversibly. It is not an absolute cut off. Cooling the limb buys time, and some limbs do well after longer, while others with crush injury do badly after less.
The patient's own vein is the best material available. It stays open better than a synthetic tube in a limb artery, and it resists infection far better in a wound that is usually contaminated. The leg it is taken from manages perfectly well without it.
That is fasciotomy. When blood returns to muscle that has been starved, it swells inside its tight fascial compartments and can cut off its own circulation again. Releasing the compartments prevents that, and the wounds are closed or grafted later.
Often not completely. The artery can be repaired reliably; nerves recover slowly and often partially, and muscle that died is replaced by scar. Expect months of rehabilitation and, in many cases, further surgery to improve function.
Because a limb that survives but is insensate, stiff and painful can leave someone less able and less comfortable than a good below knee amputation with a prosthesis. Where that is a genuine possibility it is discussed openly rather than discovered after a year of failed operations.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
