Ligation of the blood vessels

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Ligation of the blood vessels (ligation) circled around the vessel and lengthy thread (ligature) is used as a means final stop bleeding or prevent it, rarely with the aim of changing the direction of blood flow in this part of the vascular channel (for example, from superficial veins in the deep). For bandaging of blood vessels usually use silk: in ligation large vessels - silk № 4-7, small - № 1-2 (see Suture material). For bandaging small muscle of blood vessels, and vessels of medium caliber of the infected wound use catgut (one room thicker silk).
Ligation of the blood vessels produced in the wound, or through the vessel (above on a current of blood). Ligation of vessels in the wound is the most reliable way to the final stop bleeding (see). The ends of the vessel capture clips (Kocher, Piana or other), slightly tighten and anatomical tweezers is separated from the tissue. 2-10 mm from the end of the vessel (the more, the larger the vessel) surrounded by a thread (thread length 20-35 cm - the longer, the deeper is the vessel) and the ends of her tighten Maritime hub (see the surgical Sutures). Tightening the first intersection node, remove the clip and pull the second intersection, ensuring that the first weak. On the ends of a very large vessels (femoral, axillary and larger) are often placed on two ligatures on small distance from one another. The ends of strings cut the further away from the site, the thicker the thread (at bandaging blood vessels silk - 2-4 mm, catgut - 4-8 mm). Small receptacles tissue and muscles are ligated without selecting it from the surrounding tissue. On remote vessels (particularly on vessels of the brain) instead of dressing is applied clipping of vessels (see). Sometimes widely gaping wound is visible large damaged vessel that is easy to grab clip. In this case, if the delivery of wounded man to the doctor will take more than 2-2,5 hours (the period, safe for banners Assembly), to impose a ligature can and experienced nurse. The thread you need to tighten tight, but so that it does not cut through the vessel wall. The wounded were evacuated by circling around the limb of a makeshift (not drawn) harness.
Ligation of the blood vessels during produce specially made the cut. Exposing the vascular bundle, usepreview be ligation of the vessel and surround him a ligature (usually the thread is carried out Deschamps needle). Thread need to wear ear so that the short end was lying on external (curved) side of the needle and had a length of about 10 cm (too long end is difficult to pull out of the loops, short may slip). To overlay two ligatures equalize the length of both ends of the thread, and running them under a bushel, cut near the ear. Then, having moved apart thread, tighten ligatures.
The operative wound is usually tightly sewn.
The ligation of the main arteries (femoral, shoulder, and especially popliteal) forced to resort, if it is impossible vascular suture (see), as it would cause gangrene limbs. Before non-urgent operations on these vessels the necessary training collaterals, which can ensure the circulation in case of inevitability of bandaging of blood vessels. Training produce pressing artery (finger or using a special apparatus - compressor) to the root of a limb, in the groin, in axillary hole - up pulse disappears on foot, the wrist. Sessions of the pressing repeat 8-10 times a day, first for 10 minutes, then brought to 20-25 minutes efficient workout check various ways - by capillaroscopy, measuring capillary pressure, angiography. The simplest way is to test for fatigue: if disabling main artery does not cause rapid fatigue and cessation movements of the foot (bending) or hands clenching - unclamping) and the patient can continue for approximately 2 minutes, therefore, collaterals have developed enough. Usually for training of collateral circulation takes about 3-4 weeks.
If necessary, urgent bandaging traffic arteries (mainly in the military field conditions) and the lack of time for training collaterals simultaneously produce (if indicated) the dressing and corresponding Vienna. The resulting obstruction of the outflow of blood is partly compensates for its lack of inflow of a so-called reduced trunk circulation. Another way - a blood transfusion in the peripheral end tied artery, causing the expansion of collateral vascular network.
At insufficiency of blood circulation, caused by persistent spasm collaterals, it is possible to prevent gangrene, producing a lumbar or cervical-thoracic procaine blockade (see Blockade procaine) or sympathectomy (see).