Quotation from: Manual of SurgeryWritten by: Alexander Miles and Alexis Thomson |
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_Treatment._--In severe wounds of this class implicating the extremities, the most important question that arises is whether or not the limb can be saved. In examining the limb, attention should first be directed to the state of the main blood vessels, in order to determine if the vascular supply of the part beyond the lesion is sufficient to maintain its vitality. Amputation is usually called for if there is complete absence of pulsation in the distal arteries and if the part beyond is cold. If at the same time important nerve-trunks are lacerated, so that the function of the limb would be seriously impaired, it is not worth running the risk of attempting to save it. If, in addition, there is extensive destruction of large muscular masses or of important tendons, or comminution of the bones, amputation is usually imperative. Stripping of large areas of skin is not in itself a reason for removing a limb, as much can be done by skin grafting, but when it is associated with other lesions it favours amputation. In considering these points, it must be borne in mind that the damage to the deeper tissues is always more extensive than appears on the surface, and that in many cases it is only possible to estimate the real extent of the injury by administering an anaesthetic and exploring the wound. In doubtful cases the possibility of rendering the parts aseptic will often decide the question for or against amputation. If thorough purification is accomplished, the success which attends conservative measures is often remarkable. It is permissible to run an amount of risk to save an upper extremity which would be unjustifiable in the case of a lower limb. The age and occupation of the patient must also be taken into account.
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