Contemporary management of wartime vascular trauma

Abstract

This interim report represents the largest analysis of US military vascular injuries in more than 30 years. Wounding patterns reflect past experience with a high percentage of extremity injuries. Management of arterial repair with autologous vein graft remains the treatment of choice. Repairs in contaminated wound beds should be avoided. An increase in injuries from improvised explosive devices in modern conflict warrants the more liberal application of contrast arteriography. Endovascular techniques have advanced the contemporary management and proved valuable in the treatment of select wartime vascular injuries.

Tactical Surgical Intervention With Temporary Shunting of Peripheral Vascular Trauma Sustained During Operation Iraqi Freedom: One Unit??s Experience

“…The significant extent of soft tissue trauma involved with the majority of combat extremity injuries, the propensity of the leg to develop compartment syndrome with reperfusion, and the difficulty of closely following the limb's status postoperatively when receiving multiple other casualties and during subsequent MEDEVAC argue strongly for performance of distal fasciotomies in all combat casualties requiring forward intervention for vascular trauma to the leg. 18,19 The importance of this was emphasized by Johansen and Hedges in the case report of their patient who made if through a 16 hour MEDEVAC with a patent femoral artery shunt only to ultimately require amputation as a result of complications from compartment syndrome. 16 In the current series, fasciotomies were omitted in one case (Patient 9) to expedite care of one of the nine other seriously injured patients who presented concurrently.…”

Análisis del agente lesivo en la baja de combate: Experiencia de la Sanidad Militar española desplegada en Herat (Afganistán)

“…A pesar Tabla 5. Distribución por autores del mecanismo lesivo empleado [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] . de ser conflictos diferentes, presentan gran similitud desde un punto de vista logístico-operativo y asistencial.…”

Warfare Vascular Injuries

“…Following rapid evacuation and primary vascular repair in the Korean War and the Vietnam War, it dropped to approximately 15% [1]. This figure has now been reported to be 6-8% in various series from Iraq and Afghanistan [2][3][4]. Therefore preparation of all surgeons for deployment to a wartime situation must include basic knowledge and skills in vascular reconstruction techniques [5,6].…”