Gunshot wounds of major arteries; an experimental study with clinical implications
Moore, H.G.; Nyhus, L.M.; Kanar, E.A.; Harkins, H.N.
Surgery Gynecology and Obstetrics 98(2): 129-147
1954
ISSN/ISBN: 0039-6087 PMID: 13135903 Document Number: 9060
1. There are enough available published reports to indicate that many patients with gunshot wounds of major arteries -even of the aorta -can survive long enough to reach surgical care. 2. The resultant defects produced by gunshot injuries of major arteries depend upon two main factors: (I) the projection area of the missile that perforates the arterial wall, and (2) the degree to which displacement of the wall exceeds the tensile tolerance of the vessel wall. 3. Gross intimal damage usually exceeds apparent external damage in extent. 4. Microscopic damage usually extends no farther than 3 millimeters beyond the gross intimal damage. Consequently, under the conditions of our experiments, adequate debridement can be achieved by excising no more than 3 millimeters of tissue beyond the gross intimal defect. 5. Longitudinal closure of arterial defects after debridement almost always leads to undesirable narrowing of the lumen. 6. Transverse closure after partial circumferential excision of the wall almost always results in distortion of the line of blood flow. The latter may cause thrombosis at the site of repair. 7. The optimal method of debridement and repair is resection of the injured segment at least 3 millimeters beyond the gross in timal defect, followed by axial anastomosis.
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