• The first-aid tourniquet, though life-saving, should be removed as soon as it can be replaced by means such as clamps or packs that are less damaging to skin, muscle, nerves, and vessels. Ligation can result in impaired function even if no ischemia is evident; it should be done only in the smaller arteries distal to the popliteal in the leg or the brachial in the arm.
Optimum results in the treatment of injured arteries depend on technical refinements. The six case histories here given illustrate (1) the danger of hematomas underlying dense fascia, (2) the good results obtained from end-to-end anastomosis when major arteries have been transected, (3) the successful averting of gangrene by using an arterial homograft to repair a 9-cm. gap, (4) the occasional need of repeated operation of recurrent thrombosis, (5) the feasibility of ligating small peripheral arteries, and (6) the successful use of a branching arterial homograft 16 cm. in length, with recovery from claudication and ischemic ulceration, 11 years after excision of an arteriovenous fistula in the thigh. The immediate restoration of arterial flow by using grafts avoids the delay thought necessary for the development of collateral circulation. It reduces the amount of functional impairment and exemplifies restorative as distinguished from ablative surgery.