The preoperative and postoperative care of acute arterial obstruction.

Acute arterial obstruction may result not only from arterial injuries but also from thrombosis or embolism. The fate of the extremity is generally decided in the first few hours following the obstruction of the major artery. It is therefore essential that physicians should be able to recognize acute ischemia of the extremities and institute treatment which will prevent permanent damage and facilitate the reestablishment of normal circulation. Direct application of heat should be scrupulously avoided since the reduced blood flow is unable to supply increased metabolic demand. The extremity should be placed at or just below heart level so as to avoid both the ischemia of elevation and the edema of dependency. Pressure in the form of either encircling plaster or even compression bandages should be avoided and the extremity simply immobilized by a posterior splint. General supportive treatment is essential to maintain adequate pressure and composition of the arterial blood. In selected cases, agents to overcome vascular spasm or to prevent extension of intravascular thrombosis are indicated.