A system of surgery . ing for bleeding to occur. The cases in whichthe diagnosis can be made before haemorrhage occurs are very few. When an artery is ruptured subcittaneously the principles oftreatment are the same. Thus, if there is no subcutaneous haemorr-hage, the surgeons efforts are all directed to maintaining the vitalityof the anaemic parts until the anastomotic circulation is this fail, amputation at the seat of rupture must be per-formed. If blood is escaping from either end of the ruptured arterythe surgeon must cut down upon it, turn out all the effused blood,and
A system of surgery . ing for bleeding to occur. The cases in whichthe diagnosis can be made before haemorrhage occurs are very few. When an artery is ruptured subcittaneously the principles oftreatment are the same. Thus, if there is no subcutaneous haemorr-hage, the surgeons efforts are all directed to maintaining the vitalityof the anaemic parts until the anastomotic circulation is this fail, amputation at the seat of rupture must be per-formed. If blood is escaping from either end of the ruptured arterythe surgeon must cut down upon it, turn out all the effused blood,and ligature both ends of the vessel. Supposing that there hasbeen a considerable extravasation of blood from the wounded artery,but the haemorrhage from it has ceased, an incision to turn out theclots must be made, because these clots form a serious obstructionto the venous return from the parts beyond, and may even impedethe establishment of the arterial anastomotic circulation. In either 500 INJURIES OF case the clots may lead to gangrene, and it is to prevent this that they should be removed at once. When gangrene lias occurred, a amputation is the only course open. (For the treatment of traumatic aneurysm see page 632.) 2. Laceration of arteries.—It is well known that lacerated wounds are attendedwith very little, if any, haemorrhage, and forthis reason an ecraseur is used in certainoperations upon vascular tissues. When anartery is torn across, the brittle inner andmiddle coats quickly snap and curl up withinthe artery, and on them a clot forms. Theouter coat is drawn out and stretched beyondthe degree of its elasticity, and then breaks,leaving a frayed end to fall over the end of by Tearing^S6Vere the artery (Fig. 135). Such vessels oftena, The unopened vessel, showing protrude beyond the general surface of the the frayed-out [outer coat over ??• •> ° . the end of the divided inner wound, and then they can be seen pulsating coats; B, the artery lai
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