Injury to large blood vessels is very common in war wounds. Such injury is an immediate threat to both life and limb. Investigations on the battlefield have shown that the large majority of deaths on the field is due to this cause. It is well known that the large majority of the deaths in all types of war wounds occurs in the first forty-eight hours after wounding, and severe haemorrhage is again the main factor present in these cases. Where there is severe injury to a limb or internal organs damage to a main vessel has generally occurred. In abdominal injuries the early deaths are commonly associated with serious bleeding, and the same holds true in chest cases. It is for this reason that resuscitation by blood transfusion has been so eminently successful in those cases surviving long enough to reach a transfusion centre.

If life is saved, there is still present the serious danger of loss of a limb if one of the main vessels to the limb is damaged. This was known in previous campaigns, and Sir Henry Makins drew attention to it during the First World War, quoting figures to show the frequency of gangrene following ligation of main vessels. These figures showed how serious was ligature of the main vessels, but experience in the forward areas in the Second World War showed that primary ligature of main vessels is a much more serious matter -than even Makins' figures would lead one to believe.

The problem therefore is a major one, both as regards life and limb.