When the character of the lesion of the arterial wall precludes
any idea of essaying repair, the introduction of a Tuffier's tube may
be considered. Major-General Wallace has suggested this as advisable
as a means of lessening the risk of the supervention of gas gangrene,
the occurrence of which is so highly favoured by limitation of the
blood-supply to the periphery of the limb.
The operation of ligature is applicable in any case ; it requires
less perfect surroimdings and equipment than either of the other
methods ; it takes less time to perform on a patient suffering from
shock or the effects of loss of blood ; and it is likely to hold the field
as a routine procedure. The results given above indicate that
simultaneous ligature of the artery and accompanying vein should
be the rule ; also, that when only a strand of the arterial wall
remains, this should always be divided, to allow of retraction of
the ligatured ends of the vessel.
In the intermediate stage, the majority of the injuries are best
treated either by ligature or by the introduction of a Tuffier's tube.
In the remote or late stage, suture should be the invariable aim
of the surgeon. The junction tube is unnecessary, as the collateral
circulation may be relied upon ; while ligature can always be resorted
to if suture is found to be impracticable after the lesion has been
exposed.
