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Stefanou N, Arnaoutoglou C, Papageorgiou F, Matsagkas M, Varitimidis SE, Dailiana ZH. Update in combined musculoskeletal and vascular injuries of the extremities. World J Orthop 2022; 13:411-426. [PMID: 35633747 PMCID: PMC9125001 DOI: 10.5312/wjo.v13.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/31/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily. Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage, duration of limb ischemia, patient's medical status and presence of associated injuries. The management of these injuries is challenging and requires a specific algorithm of action, because they are usually characterized by increased morbidity, amputation rate, infection, neurological and functional deficits, and they could be life threatening. Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma, the high index of suspicion, imaging control, and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases. Even after a successful initial treatment of a combined trauma pattern, long-term follow-up is crucial to prevent and detect early possible complications. The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities, from an orthopedic point of view.
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Affiliation(s)
- Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Christina Arnaoutoglou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Fotios Papageorgiou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Sokratis E Varitimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
- Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Larissa 41500, Greece
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Weir A, Kennedy P, Joyce S, Ryan D, Spence L, McEntee M, Maher M, O'Connor O. Endovascular management of pelvic trauma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1196. [PMID: 34430637 PMCID: PMC8350659 DOI: 10.21037/atm-20-4591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 11/06/2022]
Abstract
Traumatic pelvic injuries are an important group of acquired pathologies given their frequent association with significant vascular compromise. Potentially fatal as a consequence of rapid hemorrhage, achievement of early hemostasis is a priority; endovascular management of traumatic pelvic arterial injuries is an important potential option for treatment. Precipitated by any number of mechanisms of trauma, pelvic vascular injury necessitates timely patient assessment. Variable patterns of arterial injury may result from blunt, penetrating or iatrogenic trauma. Selection of the most appropriate imaging modality is a priority, ensuring streamlined access to treatment. In the case of CT, this is complemented by acquisition of the most appropriate phase of imaging; review of both arterial and delayed phase imaging improves the accuracy of detection of low-flow hemorrhage. In cases where surgical intervention is not deemed appropriate, endovascular treatment provides an alternative means for cessation of hemorrhage associated with pelvic injuries. This may be achieved in a selective or nonselective manner depending on the patient's clinical status and time constraints. Consequently, a detailed understanding of vascular anatomy is essential, including an appreciation of the normal variant anatomy between males and females. Additional consideration must be given to variant anatomy which may co-exist in both sexes. This review article aims to provide a synopsis of endovascular management of pelvic vascular injury. Through case examples, available treatment options will be discussed, including thrombin injection and transcatheter arterial embolization. Furthermore, potential adverse complications of pelvic arterial embolization will be highlighted. Finally, in view of the potential severity of these injuries, a brief overview of initial management of the hemodynamically unstable patient is provided.
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Affiliation(s)
- Arlene Weir
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Padraic Kennedy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - David Ryan
- School of Medicine, University College Cork, Cork, Ireland
| | - Liam Spence
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark McEntee
- School of Medicine, University College Cork, Cork, Ireland
| | - Michael Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Owen O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
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Derbel B, Ziadi J, Daoud Z, Souiden S, Miri R, Ben Mrad M, Ghedira F, Ben Omrane S, Denguir R. [Arterial trauma of the upper limbs: Particularities of the population in Tunisia and risk factors for amputation]. Ann Cardiol Angeiol (Paris) 2020; 70:41-46. [PMID: 32859358 DOI: 10.1016/j.ancard.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY The purpose of our study was to review the population at risk of upper limb arterial injury, to determinate the rate of upper limb salvage and the predictive factors of limb loss. METHODS This was a retrospective study, involving 128 patients with upper extremity arterial trauma operated between January first, 2006 and June 30, 2017. Exclusion criteria were arterial ligation, primary limb amputation and arterial iatrogenic injuries. End points were immediate technical success, primary patency and limb salvage rate. RESULTS The average age was 27.7 years with a sex ratio M/F=41, causes of trauma were self-inflicted wounds (51%), assaults (23%), road traffic accidents (10%), work accidents (9%) and domestic accidents (7%). Injured arteries were brachial (66.5%) usually because of self-inflicted injuries; arteries of the forearm (31%) and axillery arteries (2.5%). The techniques of arterial repair were vein graft interposition in 52% of cases, end-to-end anastomosis in 23%, primary arterial repair in 21% and venous patch in 4%. Eight reconstructions occluded during the first week (6.25%). Four patients required secondary amputation and limb salvage rate was 96.8%. After a median follow-up time of 62 days, only 21% were followed at 3 months. Mechanism of injury, soft tissue loss and arterial reconstruction thromboses were selected as factors influencing the rate of limb salvage. One death occurred at day 14 secondary to multi-component poly-trauma. CONCLUSION Prompt diagnosis, appropriate multidisciplinary management of the upper extremity arterial trauma and a readiness to revise the vascular repair early in the event of failure will maximize patient survival and upper extremity salvage. Associated soft tissue injury is a poor limb salvage factor.
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Affiliation(s)
- B Derbel
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - J Ziadi
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - Z Daoud
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie.
| | - S Souiden
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - R Miri
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - M Ben Mrad
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - F Ghedira
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - S Ben Omrane
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardiovasculaire, faculté de médecine de Tunis, hôpital La-Rabta, université Tunis El-Manar, Tunis, Tunisie
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Basir A, Loncq de Jong M, Gründeman PF, van Herwaarden JA, Kluin J, Moll FL. The early days of vascular and heart valve prostheses: a historical review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:528-537. [PMID: 31486614 DOI: 10.23736/s0021-9509.19.11011-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This surgical heritage article provides a historical overview of the most important early advances of vascular- and valvular surgery, that lead to the development of currently used vascular- and valvular prostheses and materials. The first writings describing techniques in vascular surgery mainly focussed on hemorrhage control and date from around 1600 B.C. The strategy of vessel ligation was first mentioned in Western literature around 200 B.C. In the 18<sup>th</sup> century, techniques of ligation were expanded towards attempts of vessel restoration. The first artificial vascular prosthesis was made in 1894. From this time on, vascular prostheses were used in animal experiments and around 1900 for the first time in humans. More than 60 years later, in 1952, the first mechanical heart valve prosthesis was implanted. Four years later, the first successful biological heart valve implantation followed. In 2000, a transcatheter heart valve was successfully implanted in a human for the first time. Over time, procedures and techniques became more efficient and effective. This led to new developments, such as the manufacturing of a tissue engineered blood vessel in 1986. Nowadays, dozens of different valve prostheses have been devised, both mechanical and biological. Still, no ideal model of vascular and heart valve prosthesis exists.
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Affiliation(s)
- Amir Basir
- Department of Experimental Cardiology, University Medical Center, Utrecht, the Netherlands -
| | - Mylène Loncq de Jong
- Department of Experimental Cardiology, University Medical Center, Utrecht, the Netherlands
| | - Paul F Gründeman
- Department of Experimental Cardiology, University Medical Center, Utrecht, the Netherlands
| | | | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands
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Vuoncino M, Soo Hoo AJ, Patel JA, White PW, Rasmussen TE, White JM. Epidemiology of Upper Extremity Vascular Injury in Contemporary Combat. Ann Vasc Surg 2019; 62:98-103. [PMID: 31344461 DOI: 10.1016/j.avsg.2019.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/05/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of wartime upper-extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss. METHODS The Department of Defense Trauma Registry (DoDTR) was queried to identify US service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed. RESULTS Analysis identified 247 casualties who sustained 308 UEVIs. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n = 195), followed by the brachial vessels (27.3%, n = 84) and the axillary vessels (9.4%, n = 29). The predominant MOIs were penetrating explosive fragments (74.1%, n = 183) and gunshot wounds (25.9%, n = 64). Associated fractures were identified in 151 (61.1%) casualties and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management were available for 171 injuries and included repair (48%, n = 82) and ligation (52%, n = 89). The early limb loss rate was 12.1% (n = 30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion; the average injury severity score (ISS) was 32.3, and the mortality was 6.7% (n = 2). In those without amputation, the ISS and mortality were low at 20 and 4.6% (n = 10), respectively. Overall mortality was 4.9% (n = 12). CONCLUSIONS The early limb loss rate was increased compared with initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care.
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Affiliation(s)
- Matthew Vuoncino
- Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD
| | - Andrew J Soo Hoo
- Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD
| | - Jigarkumar A Patel
- Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD
| | - Paul W White
- Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD
| | - Todd E Rasmussen
- Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD
| | - Joseph M White
- Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD.
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6
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Mousa A, Zakaria OM, Hanbal I, Sultan TA, El-Gibaly AM, Zakaria MY, Nasr MA, Bosat BE, Sharabi A, Neinaa M, El-Hamid MA, Daoud MY, Amin MM, Odeh AM, Alhaieg OM, Farhan MA, Bubshait M, Al-Mulhim ARS. Operative management of non-iatrogenic pediatric and adolescence peripheral arterial trauma: An experience from a resource challenged setting. Asian J Surg 2018; 42:761-767. [PMID: 30396715 DOI: 10.1016/j.asjsur.2018.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To evaluates the management and outcome of non-iatrogenic pediatric and adolescence extremity arterial injuries in a resource-challenged setting. METHODS A retrospective study of the surgical management for non-iatrogenic extremity arterial trauma in pediatric and adolescence during the period from January 2008 to December 2015. This study was performed in two different countries at tertiary referral university and teaching hospitals having a specialized emergency and trauma centers. A thorough study of each patient record was collected from these centers including, the original demographic data and their clinical presentations. Operative data of each patient was also reported. RESULTS During the 8-year period of the study, 149 pediatric and adolescent extremity arterial trauma patients were treated. They were 93.3% male, and 6.7% female, respectively. The age ranged from 2 to 18 years with a mean of 10.25 ± 4.05 years. Lower extremity arterial trauma was recorded in 51%, while 49% were having upper extremity injuries. Primary repair with end-to-end vascular anastomosis was performed in 51.7%, while an interposition reversed saphenous vein graft was performed in 48.3%. The operative procedures were performed by an experienced vascular surgeon and well-trained pediatric surgeons and general surgeons. Pseudoaneurysms was recorded in 9% of cases. Fasciotomy was performed in 15% of cases. CONCLUSION Treatment of pediatric and adolescent extremity arterial injuries with primary end-to-end vascular anastomoses or with the use of an interposition reversed saphenous vein graft is a reliable, feasible, and more cost-effectiveness technique with good results. Moreover, it should be adopted for all vascular trauma patients, whenever possible.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt; Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
| | - Ossama M Zakaria
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia; Divisions of Pediatric Surgery, Emergency Surgery, Department of General and Emergency Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ibrahim Hanbal
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Tamer A Sultan
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amr M El-Gibaly
- Department of General, Visceral, Thoracic and Vascular Surgery, Hanse Klinikum Stralsund, University Medicine of Greifswald, Germany
| | - Mohamed Y Zakaria
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohammed A Nasr
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Bosat E Bosat
- Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Alaa Sharabi
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohamed Neinaa
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mohamed Abd El-Hamid
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohamed Y Daoud
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mahsoub M Amin
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Ahmed M Odeh
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Omer M Alhaieg
- Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mohamed A Farhan
- Divisions of Pediatric Surgery, Emergency Surgery, Department of General and Emergency Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohamed Bubshait
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdul Rahman S Al-Mulhim
- Divisions of Vascular Surgery, Pediatric Surgery, Emergency Medicine, General Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Impact of venorrhaphy and vein ligation in isolated lower-extremity venous injuries on venous thromboembolism and edema. J Trauma Acute Care Surg 2018; 84:325-329. [DOI: 10.1097/ta.0000000000001746] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Reyna-Sepúlveda F, Hernández-Guedea M, Rodríguez-García J, Martínez-Fernández A, Rodríguez-Briseño J, Muñoz-Maldonado G. Epidemiología y evolución perioperatoria de lesión vascular periférica en civiles por trauma penetrante durante una década. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bradley M, Nealeigh M, Oh JS, Rothberg P, Elster EA, Rich NM. Combat casualty care and lessons learned from the past 100 years of war. Curr Probl Surg 2017; 54:315-351. [PMID: 28595716 DOI: 10.1067/j.cpsurg.2017.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Matthew Bradley
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Matthew Nealeigh
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - John S Oh
- Division of Global Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Philip Rothberg
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Norman M Rich
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Division of Global Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
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10
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Hata KW, Propper B, Rich N. Fifty-year anniversary of the Vietnam Vascular Registry and a historic look at vascular registries. J Vasc Surg 2017; 65:267-270. [DOI: 10.1016/j.jvs.2016.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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Mavrogenis AF, Panagopoulos GN, Kokkalis ZT, Koulouvaris P, Megaloikonomos PD, Igoumenou V, Mantas G, Moulakakis KG, Sfyroeras GS, Lazaris A, Soucacos PN. Vascular Injury in Orthopedic Trauma. Orthopedics 2016; 39:249-59. [PMID: 27322172 DOI: 10.3928/01477447-20160610-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/30/2015] [Indexed: 02/03/2023]
Abstract
Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.].
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Joshi SS. Peripheral Arterial Injuries: an Indian Experience. Indian J Surg 2016; 78:187-91. [PMID: 27358512 PMCID: PMC4907906 DOI: 10.1007/s12262-015-1337-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 09/03/2015] [Indexed: 11/25/2022] Open
Abstract
Arterial injuries present the most challenging conditions in surgical practice. Many fail to reach the specialist in time and end up losing limbs or lives. Though well addressed elsewhere, it has received less attention in developing countries like India. There is a need to study these injuries from the perspective of countries like India. The aims of the study are to (1) analyze the epidemiology, presentation, and outcomes of arterial injuries operated by the author in Indian settings; (2) identify factors associated with adverse outcomes; and (3) discuss the critical issues with relevance to our country. Retrospective analysis of arterial injuries operated by the author between July 2010 and February 2014 at our institution was performed. Patients with feasibility of revascularization were included and nonviable limbs requiring primary amputations were excluded. Sixty-one patients fulfilled the criteria of which 55 (90.1 %) were males and 6 (9.8 %) females aged between 5 and 70 years. The mean duration of presentation was 21 h. Majority were resultant of road traffic accidents (62.7 %). Among 49 (80.3 %) noniatrogenic injuries, the mechanism was blunt in 46 (93.8 %, n = 49) and penetrating in 3 (6.1 %) cases. Iatrogenic injuries were seen in 12 (19.6 %) cases. Lower limbs accounted for 37 (60.6 %) cases, popliteal segment being common, 22 (36 %) cases. Bony injuries were associated in 39 (63.9 %) cases. The most common procedure was interposition graft (49.1 %). Six (9.8 %) patients required an amputation resulting in 55 (90.1 %) salvaged limbs. Reaching a specialist center in appropriate time can result in good limb salvage rates and functional outcomes. Creating awareness and training the personnel are the critical issues in the management of arterial injuries in India.
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Affiliation(s)
- Sunil S. Joshi
- St John’s Medical College Hospital, Bangalore, 560034 Karnataka India
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13
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The vital civilian-military link in combat casualty care research: Impact of attendance at scientific conferences. J Trauma Acute Care Surg 2016; 79:S221-6. [PMID: 26406434 DOI: 10.1097/ta.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Attendance by military medical personnel (MMP) at scientific meetings (SMs) of civilian associations has been centrally managed since 2012. We aimed to document the importance of civilian-military interaction to and the impact of this change on combat casualty care (CCC) research. METHODS (1) We identified 25 clinically significant CCC articles published by MMP between 2005 and 2014; we determined whether these articles were preceded by presentation by MMP at an SM. (2) We examined the changing civilian-military mix of publications on "damage control resuscitation" (DCR). (3) We analyzed the number of presentations by MMP each year at the American Association for the Surgery of Trauma. (4) We reviewed whether past presidents of the AAST (for 1992-2014) had military experience. RESULTS (1) Ninety-two percent of the CCC articles were previously presented at an SM; 66% were presented at civilian association venues such as AAST. (2) DCR was first described in 2006; the civilian-military mix of publications rose steadily from 0 in 2006 to 80% in 2014. (3) The number of MMP oral presentations at AAST peaked during 2005 to 2007 and has declined to one to two per year since 2012. (4) Thirty-three percent of recent AAST presidents had military experience, versus 100% for the previous era. CONCLUSION Recent conflicts led to intense civilian-military collaboration in CCC research and to the spread of ideas such as DCR from military to civilian care. However, long-term trends (e.g., declining rates of military service nationally) place such collaboration at risk. Vigorous efforts to foster the vital civilian-military link in CCC are needed.
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Al-Ganadi A. Management of Vascular Injury during Current Peaceful Yemeni Revolution. Ann Vasc Surg 2015; 29:1575-80. [DOI: 10.1016/j.avsg.2015.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
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Davidovic L, Tomic I, Fatic N. Homage to Professor Soubbotich and His Relavance in the Treatment of War Wounds. Ann Vasc Surg 2015; 29:1486-7. [PMID: 26253046 DOI: 10.1016/j.avsg.2015.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/09/2015] [Accepted: 07/19/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Lazar Davidovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Tomic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Fatic
- Department for Vascular Surgery, Clinical Center of Montenegro, Podgorica, Montenegro.
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Mehrzad H, Jones RG, McCafferty IJ, Mangat K. Imaging in abdominal trauma. TRAUMA-ENGLAND 2014. [DOI: 10.1177/1460408614548006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abdominal trauma is increasing and although penetrating wounds are also on the increase, blunt trauma remains more common. The cornerstone of management is accurate diagnosis and the advent of high-quality rapid CT scanning has revolutionised the treatment of serious abdominal injury. It has allowed the introduction of selective non-operative management which is applicable to many low- and intermediate-grade injuries, whereas application of interventional radiology can avert laparotomy in higher grade injuries. This review examines the pathophysiology of the commonest forms of abdominal injury and uses a series of cases to illustrate the impact of modern radiology in management.
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Affiliation(s)
- Homoyoon Mehrzad
- Department of Interventional Radiology, University Hospital Birmingham, UK
| | - Robert G Jones
- Department of Interventional Radiology, University Hospital Birmingham, UK
| | - Ian J McCafferty
- Department of Interventional Radiology, University Hospital Birmingham, UK
| | - Kamarjit Mangat
- Department of Interventional Radiology, University Hospital Birmingham, UK
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Friend J, Rao S, Sieunarine K, Woodroof P. Vascular trauma in Western Australia: a comparison of two study periods over 15 years. ANZ J Surg 2013; 86:173-8. [DOI: 10.1111/ans.12309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jikol Friend
- Departments of General and Vascular Surgery; Royal Perth Hospital; Perth Western Australia Australia
| | - Sudhakar Rao
- Departments of General and Vascular Surgery; Royal Perth Hospital; Perth Western Australia Australia
| | - Kishore Sieunarine
- Departments of General and Vascular Surgery; Royal Perth Hospital; Perth Western Australia Australia
| | - Paul Woodroof
- Departments of General and Vascular Surgery; Royal Perth Hospital; Perth Western Australia Australia
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Abstract
BACKGROUND Vertebral artery injuries (VAIs) following cervical trauma are uncommon. Advances in imaging technology and emerging endovascular therapies have allowed for the improved diagnosis and treatment of VAIs. We aimed to examine the contemporary management of combat-related penetrating VAIs during current US military operations. METHODS A retrospective review was performed on US casualties with combat-related VAIs evacuated to a single military institution in the US from September 2001 to 2010 for definitive management. Casualty demographics, mechanism of injury, location and type of VAI, neurologic sequela, associated injuries, method of diagnosis, and therapeutic management were collected. RESULTS Eleven casualties with a mean age of 26 years (mean [SD] ISS, 18 [7.0]) were found to have VAIs from gunshot wounds (6, 55%) or blast fragments (5, 45%). Cervical spine fractures (8, 72%), facial fractures (5, 45%), and spinal cord injury (3, 27%) were not uncommon. One casualty experienced a posterior cerebellar and parietal infarcts. All injuries were evaluated with digital subtraction angiography, 64-slice multidetector row computed tomography, or both. Casualties were noted to have vertebral artery occlusion (4, 36%), pseudoaneurysms (5, 45%), dissection (1, 9%), or arteriovenous fistula (1, 9%), with most injuries occurring in the V2 segment (6, 55%). Pseudoaneurysms were treated with coiling or stent-assisted coiling. Of 11 casualties, 6 were managed nonoperatively, half of whom with anticoagulation or antiplatelet therapy. CONCLUSION VAIs are infrequent in modern combat operations, occurring in only 3% of casualties experiencing arterial injuries and are often incidentally discovered during the delayed secondary evaluation of penetrating face and neck injuries at higher echelons of care. One should have a high index of suspicious for a VAI in a casualty with concurrent cervical spine fractures. Endovascular therapies using coils and covered stents have expanded the management options and simplified the treatment of combat-related VAIs. LEVEL OF EVIDENCE Therapeutic study, level V.
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Jawas A, Abbas AK, Nazzal M, Albader M, Abu-Zidan FM. Management of war-related vascular injuries: experience from the second gulf war. World J Emerg Surg 2013; 8:22. [PMID: 23816260 PMCID: PMC3700839 DOI: 10.1186/1749-7922-8-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/27/2013] [Indexed: 01/12/2023] Open
Abstract
AIM To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War. METHODS This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome. RESULTS 36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1-76) days. 5 patients died (14%). CONCLUSIONS Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.
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Affiliation(s)
- Ali Jawas
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates.
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20
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Management of secondary hemorrhage from early graft failure in military extremity wounds. J Trauma Acute Care Surg 2012; 73:818-24. [DOI: 10.1097/ta.0b013e3182587f32] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weitzel N. Vascular injuries in the perioperative period. Semin Cardiothorac Vasc Anesth 2012; 16:121-2. [PMID: 22977000 DOI: 10.1177/1089253212453094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Markov NP, DuBose JJ, Scott D, Propper BW, Clouse WD, Thompson B, Blackbourne LH, Rasmussen TE. Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark. J Vasc Surg 2012; 56:728-36. [DOI: 10.1016/j.jvs.2012.02.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/17/2012] [Accepted: 02/19/2012] [Indexed: 12/01/2022]
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Abstract
Interventional radiology (IR) has much to offer in the treatment of the trauma patient and should be integral in multidisciplinary trauma management. Many minimally invasive endovascular techniques are available with a vast amount of evidence to support their successful application. These techniques are both safe and effective and can in many circumstances negate further trauma caused by surgery in this high risk group. IR should not necessarily be considered a direct replacement for surgery as the two can often be synergistic in providing optimal care to many trauma patients. Despite the body of evidence and wealth of experience, IR is often overlooked or thought of late in trauma management when therapies are less effective. This article explores the role of IR and reviews the techniques and evidence behind their use.
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Affiliation(s)
- Robert G Jones
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK,
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Elias K, Willy C, Engelhardt M. [How much competence in emergency vascular surgery does a modern trauma surgeon need?: experiences regarding deployment as a military surgeon]. Unfallchirurg 2010; 113:122-6. [PMID: 20107760 DOI: 10.1007/s00113-010-1740-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Management of combat-related major vascular injuries is a challenge to all surgeons and a vascular specialist will not always be available in a wartime setting; therefore, every surgeon deployed to a war setting must be able to cope with these life and limb-threatening injuries. Data obtained from searching Medline and Google on the localization and treatment of combat-related vascular injuries of the USA strike forces in Afghanistan and Iraq were analyzed and adjusted to the requirements of the German Armed Forces. A total of 5-7% of casualties sustained major vascular injuries. After initial treatment using damage control measures to control the bleeding and restore perfusion definitive repair with vascular reconstruction must be performed in a facility with a higher level of care. Basic vascular surgical techniques which all military surgeons need to know are presented taking the austere conditions of a wartime environment into consideration. Preparation of all surgeons for deployment to a wartime situation must include basic knowledge and skills in vascular surgery including emergency and vascular reconstruction techniques.
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Affiliation(s)
- K Elias
- Klinik für Gefässchirurgie, Chirurgisches Zentrum, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
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Abstract
The battlefield has provided a multitude of advancements in the management of hemorrhage and vascular repair. Basic understanding of the anatomy and exposures of lower extremity injuries is essential to any surgeon caring for these patients. The techniques of repair and potential adjunctive measures (eg, shunts) available should always be considered when approaching a vascular injury. The most important concept from a vascular standpoint is the fact that a multidisciplinary approach to these complex patients is required with maximal tissue preservation when feasible and safe.
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Bains S, Vlachou P, Rayt H, Dennis M, Markose G, Naylor A. An observational cohort study of the management and outcomes of vascular trauma. Surgeon 2009; 7:332-5. [DOI: 10.1016/s1479-666x(09)80105-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Manring MM, Hawk A, Calhoun JH, Andersen RC. Treatment of war wounds: a historical review. Clin Orthop Relat Res 2009; 467:2168-91. [PMID: 19219516 PMCID: PMC2706344 DOI: 10.1007/s11999-009-0738-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 01/27/2009] [Indexed: 01/31/2023]
Abstract
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.
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Affiliation(s)
- M. M. Manring
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO USA
| | - Alan Hawk
- National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, DC USA
| | - Jason H. Calhoun
- Department of Orthopaedic Surgery, The Ohio State University, N1043 Doan Hall, 410 W 10th Ave, Columbus, OH 43210-1228 USA
| | - Romney C. Andersen
- Orthopaedic Traumatology, Walter Reed National Military Medical Center, Bethesda, MD USA
- Orthopaedic Traumatology, Walter Reed National Military Medical Center, Washington, DC USA
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30
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Vascular Trauma. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Acute venous disease: Venous thrombosis and venous trauma. J Vasc Surg 2007; 46 Suppl S:25S-53S. [DOI: 10.1016/j.jvs.2007.08.037] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 08/15/2007] [Accepted: 08/19/2007] [Indexed: 10/22/2022]
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Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Caronno R, Laganà D, Carrafiello G, Castelli P. Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma. Injury 2007; 38:1091-7. [PMID: 17543309 DOI: 10.1016/j.injury.2007.02.044] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 02/25/2007] [Accepted: 02/26/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The continued advances in imaging and stent/stent-graft technology have considerably expanded the indications for endovascular approach also in vascular trauma. We report our institutional experience with endovascular treatment of peripheral arterial injuries after blunt trauma. METHODS Between January 2000 and June 2006 out of a series of 81 patients, 10 male patients (mean age of 50+/-14 years) with peripheral arterial injuries were managed endovascularly. At admission, haemorrhagic shock was present in three patients. Artery location involved common femoral (n=2), subclavian (n=2), axillary (n=2), external iliac (n=2), superficial femoral (n=1), and popliteal (n=1). Type of lesion was as follows: pseudoaneurysm (n=4), dissection (n=4), expanding haematoma (n=1), and arterio-venous fistula (n=1). Follow-up program included visit and duplex-ultrasonography, X-rays and/or spiral-computed tomography at 6-month interval during the first year, and yearly thereafter. RESULTS The lesion was excluded in all cases. All patients survived. Major complications did not occur. Mean hospitalisation was 13 days. Limb-salvage was 100%. Follow-up ranged from 3 to 60 months (mean 16); a late occlusion of a popliteal stent-graft was managed with another endovascular procedure. CONCLUSION In our experience, endovascular treatment of vascular injuries after blunt trauma was feasible and effective.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery-Department of Surgery, University of Insubria-Varese, Italy.
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Greaby R, Zderic V, Vaezy S. Pulsatile flow phantom for ultrasound image-guided HIFU treatment of vascular injuries. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1269-76. [PMID: 17466441 PMCID: PMC2692665 DOI: 10.1016/j.ultrasmedbio.2007.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 02/04/2007] [Accepted: 02/13/2007] [Indexed: 05/15/2023]
Abstract
A pulsatile flow phantom was developed for studies of ultrasound image-guided high intensity focused ultrasound (HIFU) application in transcutaneous hemostasis of injured blood vessels. The flow phantom consisted of a pulsatile pump system with instrumented excised porcine carotid artery, which was imbedded in a transparent agarose gel to model structural configuration of in vivo tissues. Heparinized porcine blood was circulated through the phantom. The artery was injured using an 18-gauge needle to model a penetrating injury in human peripheral vasculature. A HIFU transducer with the diameter of 7 cm, focal length of 6.3 cm and frequency of 3.4 MHz was used to seal the puncture. Ultrasound imaging was used to localize and target the puncture site and to monitor the HIFU treatment. Triphasic blood flows present in the human arteries were reproduced, with flow rates of 50 to 500 mL/min, pulse rates of 62 to 138 beats/min and peak pressures of 100 to 250 mm Hg. The penetrating injury of an artery was mimicked successfully in the flow phantom setting and was easily visualized both optically through the transparent gel and with power Doppler ultrasound imaging. Hemostasis was achieved in 55 +/- 31 s (n = 9) of HIFU application. Histologic observations showed that a HIFU-sealed puncture was filled with clotted blood and covered with a fibrin cap. The pulsatile flow phantom provides a controlled and repeatable environment for studies of transcutaneous image-guided HIFU application in hemostasis of a variety of blood vessel injuries.
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Affiliation(s)
- Robyn Greaby
- Department of Bioengineering, University of Washington
| | - Vesna Zderic
- Department of Electrical and Computer Engineering, The George Washington University
| | - Shahram Vaezy
- Department of Bioengineering, University of Washington
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D'Angelo F, Piffaretti G, Carrafiello G, Tozzi M, Caronno R, Castelli P, Zatti G. Endovascular repair of a pseudo-aneurysm of the common femoral artery after revision total hip arthroplasty. Emerg Radiol 2007; 14:233-6. [PMID: 17406911 DOI: 10.1007/s10140-007-0605-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
Vascular injuries with acute arterial haemorrhage are rare but the infrequency of these complications may make their diagnosis and treatment challenging for surgeons unfamiliar with their management. In the past, surgery or coil embolisation has been used to treat these lesions; we describe the case of a pseudo-aneurysm of the common femoral artery developed during a total hip arthroplasty, promptly managed with an endovascular stent graft.
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Affiliation(s)
- F D'Angelo
- Department of Orthopaedic and Traumatologic Sciences, University of Insubria, Varese, Italy
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Clouse WD, Rasmussen TE, Peck MA, Eliason JL, Cox MW, Bowser AN, Jenkins DH, Smith DL, Rich NM. In-Theater Management of Vascular Injury: 2 Years of the Balad Vascular Registry. J Am Coll Surg 2007; 204:625-32. [PMID: 17382222 DOI: 10.1016/j.jamcollsurg.2007.01.040] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 01/08/2007] [Accepted: 01/17/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Wartime vascular injury management has traditionally advanced vascular surgery. Despite past military experience, and recent civilian publications, there are no reports detailing current in-theater treatment. The objective of this analysis is to describe the management of vascular injury at the central echelon III surgical facility in Iraq, and to place this experience in perspective with past conflicts. STUDY DESIGN Vascular injuries evaluated at our facility between September 1, 2004 and August 31, 2006 were prospectively entered into a registry and reviewed. RESULTS During this 24-month period, 6,801 battle-related casualties were assessed. Three hundred twenty-four (4.8%) were diagnosed with 347 vascular injuries. Extremity injuries accounted for 260 (74.9%). Vascular injuries in the neck (n = 56; 16.1%) and thoracoabdominal domain (n = 31; 8.9%) were less common. US forces accounted for 149 casualties (46%), 97 (30%) were local civilian, and 78 (24%) were Iraqi forces. One hundred seven (33%) patients with vascular injury were evacuated from forward locations after treatment initiation. Fifty-four (50%) of these had temporary shunts placed. Of 43 proximal shunts placed in-field, 37 (86%) were patent at the time of our assessment. Early amputation rate was 6.6% for those extremity injuries treated for limb salvage. Perioperative mortality was 4.3%. CONCLUSIONS This evaluation represents the first in-theater report of wartime vascular injury since Vietnam. Extremity injuries continue to predominate, although the incidence of vascular injury appears to be somewhat increased. Local forces and civilians now represent a substantial proportion of those injured. The principles of rapid evacuation, temporary shunting, and early reconstruction are effective, with satisfactory early in-theater limb salvage.
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Affiliation(s)
- W Darrin Clouse
- 332nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq.
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Fox CJ, Gillespie DL, Weber MA, Cox MW, Hawksworth JS, Cryer CM, Rich NM, O'Donnell SD. Delayed evaluation of combat-related penetrating neck trauma. J Vasc Surg 2006; 44:86-93. [PMID: 16828429 DOI: 10.1016/j.jvs.2006.02.058] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 02/19/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The approach to penetrating trauma of the head and neck has undergone significant evolution and offers unique challenges during wartime. Military munitions produce complex injury patterns that challenge conventional diagnosis and management. Mass casualties may not allow for routine exploration of all stable cervical blast injuries. The objective of this study was to review the delayed evaluation of combat-related penetrating neck trauma in patients after evacuation to the United States. METHOD From February 2003 through April 2005, a series of patients with military-associated penetrating cervical trauma were evacuated to a single institution, prospectively entered into a database, and retrospectively reviewed. RESULTS Suspected vascular injury from penetrating neck trauma occurred in 63 patients. Injuries were to zone II in 33%, zone III in 33%, and zone I in 11%. The remaining injuries involved multiple zones, including the lower face or posterior neck. Explosive devices wounded 50 patients (79%), 13 (21%) had high-velocity gunshot wounds, and 19 (30%) had associated intracranial or cervical spine injury. Of the 39 patients (62%) who underwent emergent neck exploration in Iraq or Afghanistan, 21 had 24 injuries requiring ligation (18), vein interposition or primary repair (4), polytetrafluoroethylene (PTFE) graft interposition (1), or patch angioplasty (1). Injuries occurred to the carotid, vertebral, or innominate arteries, or the jugular vein. After evacuation to the United States, all patients underwent radiologic evaluation of the head and neck vasculature. Computed tomography angiography was performed in 45 patients (71%), including six zone II injuries without prior exploration. Forty (63%) underwent diagnostic arteriography that detected pseudoaneurysms (5) or occlusions (8) of the carotid and vertebral arteries. No occult venous injuries were noted. Delayed evaluation resulted in the detection of 12 additional occult injuries and one graft thrombosis in 11 patients. Management included observation (5), vein or PTFE graft repair (3), coil embolization (2), or ligation (1). CONCLUSIONS Penetrating multiple fragment injury to the head and neck is common during wartime. Computed tomography angiography is useful in the delayed evaluation of stable patients, but retained fragments produce suboptimal imaging in the zone of injury. Arteriography remains the imaging study of choice to evaluate for cervical vascular trauma, and its use should be liberalized for combat injuries. Stable injuries may not require immediate neck exploration; however, the high prevalence of occult injuries discovered in this review underscores the need for a complete re-evaluation upon return to the United States.
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Affiliation(s)
- Charles J Fox
- Department of Surgery, Vascular Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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O'Donnell SD, Gillespie DL, Goff JM, Rasmussen TE, Johnson CA, Fox CJ. Norman M. Rich--the Walter Reed Vascular Surgery Fellowship. World J Surg 2005; 29 Suppl 1:S72-3. [PMID: 15815826 DOI: 10.1007/s00268-004-2066-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sean D O'Donnell
- Peripheral Vaspular Surgery Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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Fox CJ, Gillespie DL, O’Donnell SD, Rasmussen TE, Goff JM, Johnson CA, Galgon RE, Sarac TP, Rich NM. Contemporary management of wartime vascular trauma. J Vasc Surg 2005; 41:638-44. [DOI: 10.1016/j.jvs.2005.01.010] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Diamond S, Gaspard D, Katz S. Vascular Injuries to the Extremities in a Suburban Trauma Center. Am Surg 2003. [DOI: 10.1177/000313480306901006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the experience with extremity vascular injuries of a level II suburban trauma center. A retrospective chart review was undertaken to include all patients admitted in a 6-year period with vascular injuries to the extremities. The vessels injured were identified along with the mechanism of injury. The method of repair was recorded. All associated neurologic injuries were investigated. Follow-up records, when available, were reviewed. Between January 1, 1996, and November 30, 2002, 48 patients were admitted with 56 vascular injuries to the extremities. Blunt trauma was the mechanism in 24 patients while penetrating trauma was the mechanism in the other 24 patients. The limb salvage rate was 95 per cent. Of the 28 injuries to upper extremity vessels, 24 were associated with neurologic injuries. In contrast, only 3 neurologic injuries were found in patients with lower extremity vascular injuries. In contrast to most urban centers, the distribution of vascular injuries to the extremities in a suburban setting was equally divided between blunt and penetrating injuries. The majority of functional impairment was related to neurologic injury rather than tissue ischemia from vascular injury.
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Affiliation(s)
- Scott Diamond
- From the Division of Vascular Surgery, Keck School of Medicine, Huntington Hospital, Pasadena, California
| | - Donald Gaspard
- From the Division of Vascular Surgery, Keck School of Medicine, Huntington Hospital, Pasadena, California
| | - Steven Katz
- From the Division of Vascular Surgery, Keck School of Medicine, Huntington Hospital, Pasadena, California
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Abstract
This article addresses failed arterial and venous repairs, thrombosed vessels and bypasses, postoperative pseudoaneurysms and arterio-venous fistulas. Management techniques for these complications are reviewed and morbidity and mortality rates provided.
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Affiliation(s)
- Norman M Rich
- Department of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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