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

Outcome after vascular trauma in a deployed military trauma system

“…Although vascular shunting has been popularized as a damage control technique 8,9 , and the training of UK military surgeons has been focused concordantly, no patient received a shunt in this series. This is explained only partly by the fact that, although previous reports have described the value of this technique for patients treated in far-forward and isolated surgical resuscitation sites, such facilities have not been required to support UK military operations in either Afghanistan or Iraq.…”

Acute ischemia of the lower limb after injury by gunshot: case report and review of literature

“…Orthopaedic, soft tissue and neurosensory status should always be investigated and dealt with properly. Scenarios observed in the military setting, where revascularization often needs to be delayed, have proved to be of great importance in reducing limb amputation rates [20][21][22][23].…”

Surgical Damage Control and Temporary Vascular Shunts

“…While flow rates are lower than their arterial counterparts, the patency of venous shunts is comparable. [21][22][23] Successful use of vascular shunts in venous injuries has also been reported the civilian sector as Parry and colleagues have described 18 cases either to allow for orthopedic fixation or to control hemorrhage during a damage control operation. All venous shunts in their series were patent on reexploration at a mean 22 hours dwell time.…”

“…This determination can often be aided by the use of continuous-wave Doppler. [21][22][23][24][25][26][27][28][29] In cases where there is injury to more than one of the small distal arteries (e.g., both ulnar and radial arteries) resulting in an absence of Doppler signal beyond the injury, use of a vascular shunt is recommended. 33 Those who have extensive experience with placing shunts frequently state that in the setting of penetrating vascular injury, the two ends of the severed vessel must be exposed for ligation anyway.…”

“…21 The favorable experience with the use of vascular shunts in this initial report was corroborated by subsequent series provided by other combat surgical teams. [22][23][24] Figures 17-2, A-C detail a case example in which a midsubclavian injury was initially treated at a forward surgical location with the insertion of an intraluminal shunt and subsequently was repaired with interposition graft at a higher level of care. Gifford and colleagues provided one of the only studies to characterize longer-term extremity outcomes following the use of temporary vascular shunts.…”