death from exsanguination and sepsis, rather than did repair to salvage a limb. As a result, amputation was com- mon after peripheral vascular injury.
De Bakey and Sirneone, in their classic work describing 247 1 vascular injuries sustained by American forces in World War 11, stated that ligation was “riot a procedure of choice. It is a procedure of stem necessity, for the purpose of controlling hemorrhage."' In extremities that survived vas- cular ligation, the thrombosis, false aneurysms, and AVFs that later developed then could be repaired electively. Un-
fortunately, even salvaged limbs following arterial ligation had severe functional disability 6 Nonetheless, such delayed
repair of vascular trauma was believed superior to immediate repair, because it was thought to provide the opportunity for collateral circulation to develop to improve the chances of ultimate limb viability. This philosophy and practice per- sisted into the early part of the Korean War.’ De Bakey and Simeone' advocated this approach by noting “The almost negligible irrciclence of loss of limb after excision of false aneurysiris prompts the rather paradox ical statement that the best safeguard for the survival of a limb is to permit an aciite arterial wound to develop into an aneurysm” (p 563).
Makins' docctmented an amputation rate of 16.4% in the British casualties of World War I, while De Bakey and
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