Single centre experience of combat-related vascular injury in victims of Syrian conflict: Retrospective evaluation of risk factors associated with amputation

Şişli, Emrah; Kavala, Ali Aycan; Mavi, Mustafa; Sariosmanoğlu, Osman Nejat; Oto, Öztekin

doi:10.1016/j.injury.2016.03.030

Cited by 15 publications

(18 citation statements)

References 21 publications

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“…In total, 38 publications met the inclusion criteria of this systematic review as shown in Figure 1 10–47. There was no other systematic review on this area of research found.…”

Section: Resultsmentioning

confidence: 99%

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Syrian Civil War: a systematic review of trauma casualty epidemiology

McIntyre¹

2020

BMJ Mil Health

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BackgroundThe Syrian Civil War has caused over 400 000 traumatic deaths. Understanding the nature of war casualties is crucial to deliver healthcare improvement. Historic regional conflicts and Syrian mortality data have been characterised by blast injuries. The aim of this novel review is to assess the trauma epidemiology of Syrian Civil War casualties from the perspective of healthcare facilities.MethodsThis review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Studies addressing Syria, trauma and war were investigated. Eligibility criteria included being conducted from a healthcare facility, published in English and peer reviewed. The outcomes were demography, mechanism of injury and anatomical injury site.Results38 papers satisfied the eligibility criteria. 13 842 casualties were reported across the entire data set. Casualties were 88.8% male (n=4035 of 4544). Children contributed to 16.1% of cases (n=398 of 2469). Mortality rate was 8.6% (n=412 of 4774). Gunshot wound was the most common mechanism of injury representing 66.3% (n=7825 of 11799). Head injury was the most common injured site at 26.6% (n=719 of 2701).ConclusionsThis conflict has a distinct trauma profile compared with regional modern wars. The prevalence of gunshot wounds represents a marked change in mechanism of injury. This may be related to higher mortality rate and proportion of head injuries identified. This review cannot correlate mechanism of injury, demographics or injuries sustained to outcomes. The quality of data from the included studies lacked standardisation; future research and consistent reporting tools are required to enable further analysis.

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“…In total, 38 publications met the inclusion criteria of this systematic review as shown in Figure 1 10–47. There was no other systematic review on this area of research found.…”

Section: Resultsmentioning

confidence: 99%

“…Seven papers did not indicate the gender of the casualties 10 11 15 23 26 29 40. Eight papers met the eligibility criteria and had specific data for children aged less than 18 years 12 13 19 24 27 44–46. Nine other papers were excluded due to being specific to childhood trauma 18 30–33 47.…”

Section: Resultsmentioning

confidence: 99%

Syrian Civil War: a systematic review of trauma casualty epidemiology

McIntyre¹

2020

BMJ Mil Health

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“…Brown et al [23] reported that the extremity is preserved in 35.7% of the patients whose MESS is ≥7, although this score in fact indicates a high probability of amputation. Şişli et al [24] found in their study that the extremity is kept in 60% of patients who have MESS >7, and that the MESS scoring system is not in itself a sufficient criterion to determine amputation. In our study, MESS was used as a scoring system, and revascularization was performed despite the fact that 51 (53%) of 96 patients had MESS ≥7.…”

Section: Discussionmentioning

confidence: 98%

Effect of temporary vascular shunting as a previous intervention on lower extremity arterial injury: single centre experiences in syrian civil war

Hasde

Baran

Gümüş

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention. METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72). RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84±1.84 h in the TVS group and 5.95±1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant. CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.

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“…En los hallazgos clínicos de los pacientes objeto de estudio, el principal signo duro de trauma vascular fue el sangrado pulsátil (59,3 %), seguido de ausencia de pulso (25,9 %) y hematoma expansivo (24 %); respecto a los signos blandos, el principal fue la herida en trayecto vascular; una cohorte de 92 pacientes muestra que la presencia de signos duros fue de un 77 %, en cuyo caso la ausencia de pulso fue el principal signo (40 % de los pacientes), seguido de sangrado pulsátil (26,8 %) y hematoma expansivo (2,3 %) 10,16 . Otros estudios muestran una prevalencia de signos duros del 29,3 %, dato que es inferior a lo observado en nuestro estudio 9 . En lo concerniente a los resultados sobre hallazgos intraoperatorios, se evidencian lesiones con compromiso de extremidades, mayormente de miembros superiores (arteria cubital y radial), seguida por lesiones en miembros inferiores (arteria femoral común), datos que van de la mano con resultados de estudios locales e internacionales [3][4][5]10,14 .…”

Section: Termino-terminalunclassified

“…Entre los procedimientos requeridos en la reparación de estas lesiones están las ligaduras vasculares, los reparos primarios y el baipás o la embolización selectiva; tales procedimientos generan complicaciones postquirúrgicas como trombosis o estenosis del reparo (3 %), infección del sitio operatorio con necesidad de reintervención (1,1 %), reintervención por alguna causa relacionada con el procedimiento inicial (7,7 %) y amputaciones (3,3 -29 %) 7,8 . La mortalidad relacionada con estas lesiones es de aproximadamente un 2 -22,9 % 5,6,9 , valores que cambian de acuerdo con variables como la energía del mecanismo de la lesión, el tiempo de evolución a la atención, el sitio de la lesión, las lesiones asociadas, el tipo de reparo y las características operativas de la cirugía inicial, entre otras 2,10 ; se han relacionado además como influyentes en la aparición de complicaciones tras el reparo de las lesiones vasculares.…”

Section: Introductionunclassified

Caracterización de trauma arterial periférico en un hospital de tercer nivel

et al. 2018

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ResumenIntroducción. El trauma vascular es un evento de baja frecuencia, con alta carga de morbilidad y mortalidad, que afecta mayormente a hombres jóvenes y en muchas ocasiones requiere manejo quirúrgico. Se asocia con múltiples complicaciones, que van desde la reintervención quirúrgica, hasta la amputación de la extremidad, las cuales, a su vez, se ven influenciadas por variables relacionadas tanto con el trauma como con la atención hospitalaria. Objetivo. Caracterizar los pacientes mayores de 13 años con traumatismos arteriales periféricos en el Hospital Universitario Hernando Moncaleano Perdomo, de Neiva, Huila, Colombia, en el periodo enero de 2014 a diciembre de 2016. Materiales y métodos. Estudio observacional, retrospectivo, de tipo descriptivo, con población a conveniencia de pacientes mayores de 13 años que sufrieron traumatismos arteriales periféricos y fueron llevados a procedimiento quirúrgico en el Hospital Universitario Hernando Moncaleano Perdomo. Resultados. Se encontraron 54 pacientes con trauma arterial periférico, cifra que representa el 1,5 % de los ingresos por trauma en la Institución durante el período de estudio. El género más representativo fue el masculino (n=49), las heridas por arma cortopunzante el principal mecanismo de trauma (n=22) y las extremidades el área comúnmente afectada (n=47). Se halló un puntaje de gravedad de la lesión promedio al ingreso de 26 puntos, y un tiempo de isquemia de extremidad mayor a seis horas al momento del ingreso en el 31,5 % de los casos (n=17). Conclusiones. Las intervenciones quirúrgicas fueron hechas en mayor medida por cirugía de trauma, seguido de cirugía vascular. El principal manejo fue la anastomosis término-terminal y el injerto de safena invertida. Las complicaciones fueron en mayor medida la trombosis arterial (n=12), seguida de la amputación de extremidad (n=7). Palabras clave: lesiones del sistema vascular; heridas penetrantes; traumatismo múltiple; extremidad inferior; extremidad superior; procedimientos quirúrgicos vasculares.https://doi.org/10. 30944/20117582.72 273 Rev Colomb Cir. 2018;33:272-79 Trauma arterial periférico AbstractIntroduction. Vascular trauma is a low frequency event, with a high burden of morbidity and mortality that mostly affects young men. It often requires surgical management, which is associated with multiple complications ranging from reoperation to limb amputation; that in turn, are influenced by variables associated with both trauma and hospital care. Objective. To characterize the patients over 13 years of age with peripheral arterial trauma admitted to the Hernando Moncaleano Perdomo University Hospital, Neiva, Colombia, from January 2014 to December 2016. Methods. Retrospective observational study of descriptive type with population of patients older than 13 years with peripheral arterial trauma who had a surgical procedure at the Hernando Moncaleano Perdomo University Hospital.Results. This study showed that the 54 patients with peripheral arterial trauma represented 1.5% of the total trauma admissi...

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Single centre experience of combat-related vascular injury in victims of Syrian conflict: Retrospective evaluation of risk factors associated with amputation

Cited by 15 publications

References 21 publications

Syrian Civil War: a systematic review of trauma casualty epidemiology

Syrian Civil War: a systematic review of trauma casualty epidemiology

Effect of temporary vascular shunting as a previous intervention on lower extremity arterial injury: single centre experiences in syrian civil war

Caracterización de trauma arterial periférico en un hospital de tercer nivel

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