Improvised explosive device related pelvi-perineal trauma

Abstract

Improvised explosive device-related perineal injuries with pelvic fractures had the highest rate of mortality compared with perineal injuries alone. Early aggressive resuscitation (activation of the massive hemorrhage protocol) is essential to survival in this cohort. Our recommendations are uncompromising initial debridement, immediate fecal diversion, and early enteral feeding.

Concept and evaluation of the German War Surgery Course – Einsatzchirurgie-Kurs der Bundeswehr

“…Various military medical training course concepts have been established on a national 8 12 13 or an international basis 11. Future military medical trainings must take into account the increasing use of multinational medical teams in military and humanitarian missions.…”

“…The Advanced Surgical Skills for Exposure in Trauma (ASSET) course has been shown to increase confidence with and performance of vascular exposure skills and has been incorporated into the Emergency War Surgery Course used by the US Military for predeployment training 12. Especially for military needs, also other surgical training courses have been established on a national basis, such as the British Military Operational Surgical Training predeployment course13 or the French Advanced Course for Deployment Surgery (ACDS) 8…”

Developing a cumulative anatomic scoring system for military perineal and pelvic blast injuries

“…This study was an extension of an analysis of a previously described cohort of patients in order to better understand risk factors and develop a tool for future audit and performance improvement 3. A retrospective search of the Joint Theatre Trauma Registry (JTTR) held at the Royal Centre for Defence Medicine (RCDM) Birmingham was carried out to identify all perineal injuries sustained by British servicemen and women over an 8-year period from 1 January 2003 to 31 December 2010.…”

“…In previous conflicts landmines caused relatively simple below knee amputations, whereas increased improvised explosive device (IED) yields now create a more proximal injury pattern with bilateral high transfemoral amputations and junctional area injuries (Figure 1). As the injury level gets higher, the likelihood of pelvic and perineal injury also increases,2 as does the logistical and surgical burden imposed by IED's 3. One of the difficulties has been accurate delineation of the extent of the perineal injury.…”

“…It is hoped that this will result in better surgical team performance and a continued improvement in our survival rates (currently only 27% for combined pelvic and perineal injuries) for these critically (and maximally) injured casualties 3. In Afghanistan presently, there is the relative luxury of a fully mature trauma system with a robust logistic chain that can, on demand, supply large quantities of blood, plasma, platelets and oxygen.…”