Stitching Arteries

A torn artery and a pulsating fountain of blood usually meant one thing to Army surgeons in World War I--amputation. In World War II, it may not mean any such thing. In the American Journal of Surgery last week, Surgeon Gerald Hillary Pratt published instructions on the "neglected" art of sewing arteries:

First step is to stop the spurting blood, by tourniquet or by a surgical clamp applied directly to the bleeding vessel. Next, remove blood clots (which form in about 50% of the cases) with forceps or a corkscrew of silver wire. Then, if no more than two inches of artery have been lost, the torn arterial ends can be stitched together with a hairlike needle and fine silk. The needle must not enter the tender inner lining of the artery, but only its tough coat. After the artery is joined, a strip of nearby muscle can be wrapped around the suture to reinforce it.

When a large piece of artery has been torn away, a nearby vein can be tied off and a piece cut out for a patch. (Smaller, "collateral veins" can always take up the circulation of the large ones.) Even when it is impossible to repair an artery, Dr. Pratt continued, amputation is still not inevitable, for, like a vein, an artery can be ligated (tied off from circulation). There is small danger of gangrene if the accompanying vein is also ligated.

Once an artery has been ligated or repaired, the collateral blood vessels can be stimulated by:

>> Keeping the limb at a temperature of 88DEG to 96DEG F.

>> Placing the patient in a special oscillating bed, or gently raising, leveling and lowering his limb for mild massage.

>> Giving the patient a couple of snifters of whiskey, "one of the best" circulatory stimulants. The old routine of "sticking a cigaret in a wounded soldier's mouth" is very dangerous. Reason: smoking, "without question," causes the small blood vessels to tighten up.

-- Distant cousin of Preacher Harry Emerson Fosdick.

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