A major vessel divided by injury starts a clock. Muscle begins to die after roughly six hours without blood supply, and once that happens restoring flow can release breakdown products that damage the kidneys and heart. This is emergency work, not urgent work.
The sequence is consistent: control bleeding, expose the vessel above and below the injury, clear the clot, trim back to healthy wall, and then repair directly or bridge the gap with the patient's own vein. The fascial compartments are usually released at the same operation, because swelling after flow returns can cut off the circulation all over again.
The part that is often missed is cover. A repaired vessel lying in an open wound dries out, becomes infected and eventually bleeds. Planning the soft tissue cover in the same operation is what stops that happening.
Most seriously injured limbs involve more than one of these at once.
When blood returns to starved muscle it swells inside its tight fascial compartments and can cut off its own circulation again. Fasciotomy prevents that second catastrophe. The wounds are closed or grafted later.
The patient's own vein resists infection in a contaminated wound and stays open better in limb arteries. Synthetic grafts in dirty wounds usually become infected and have to be removed.
A limb that survives but is numb, stiff and painful can leave someone less able than a good below knee amputation with a prosthesis. Where that is a real possibility it is discussed openly rather than discovered after a year.
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 often further surgery.
These are the findings that change the urgency of an injury. Any of them warrants going straight to an emergency department.
Asked almost always in the first hours, usually by relatives.
Ask your question →Roughly six hours of warm ischaemia is the figure usually quoted, because that is when muscle begins to die irreversibly. It is not an absolute cut off. Cooling buys time, and a crush injury can do badly after less while a clean division can do well after more.
That is fasciotomy, releasing the tight compartments so that muscle swelling after flow returns does not choke off the circulation. The wounds are closed or skin grafted once the swelling has settled.
It is the best conduit available for a limb artery: it stays open better than synthetic material and resists infection far better in a wound that is usually contaminated. The donor leg manages without it.
Often not completely. Restoring flow saves the tissue; function depends mainly on the nerve and muscle damage sustained at the time. Rehabilitation takes months and further operations are common.
Emergency vascular trauma is commonly covered by health insurance and by government schemes including PM JAY. Treatment is never delayed for a financial discussion.
