Extremity Vascular Injuries on the Battlefield: Tips for Surgeons Deploying to War

Starnes, Benjamin W.; Beekley, Alec C.; Sebesta, James A.; Andersen, Charles A.; Rush, Robert M.

doi:10.1097/01.ta.0000197628.55757.de

Cited by 132 publications

(88 citation statements)

References 21 publications

(23 reference statements)

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“…They noted that vascular injuries of the extremities accounted for 50% to 70% of all injuries treated during Operation Iraqi Freedom, and exsanguination from extremity wounds was the leading cause of preventable death on the battlefield. 7 In Kuwait, Asfar et al looked at 155 patients from 1992-2000, most of whom had vascular trauma of the extremities (76%). The most common procedure was revascularisation, primarily with the long saphenous vein, via a direct repair or end-toend anastomosis.…”

Section: Discussionmentioning

confidence: 99%

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

Ramdass

Harnarayan

2017

annals

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INTRODUCTION Trinidad and Tobago is a trans-shipment point for the illegal trade of drugs, arms and ammunition and, as such, has a high incidence of gang-related warfare and drug-related crimes. This has led to a high incidence of gunshot and stab wounds, with associated major vascular injuries. We describe our management strategies learned from a decade of vascular trauma experience. METHODS A retrospective analysis of age, gender, type of trauma, vessel injured, procedure and outcome for all cases of vascular trauma between 2006 and 2015 at two surgical units in Trinidad and Tobago. RESULTS There were 198 vascular trauma cases (232 procedures), involving 159 (80%) males at a mean age of 33 years. Gunshots accounted for 103 (52%) cases, followed by stabs/chops (n=50; 25%) and lacerations (n=15; 8%). The most commonly injured vessels were the radial/ulnar arteries (n=39; 20%) and the superficial femoral artery (n=37; 19%). There were seven pseudoaneurysms and three traumatic arteriovenous fistulae. Repair techniques included primary (n=82; 35%), reversed vein (n=63; 27%), polytetrafluoroethylene (n=58; 25%), oversew (n=24; 10%) and endovascular (n=5; 2%) techniques. There were eight (4%) secondary amputations and eight (4%) deaths. CONCLUSIONS Major vascular trauma causes significant morbidity and mortality in Trinidad and Tobago, with the majority of cases due to gunshot injuries secondary to gang-related warfare and civilian violence. We compare our experience with that in the literature on the epidemiology and management of vascular trauma.

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Section: Discussionmentioning

confidence: 99%

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

Ramdass

Harnarayan

2017

annals

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“…Since the late 1980's, incidence of vascular injuries has increased due to an increase in number of assaults, motor vehicle crashes and percutaneous medical procedures (Caps 2000). Furthermore, in recent United States military warfare, up to 70% of all treated injuries are extremity vascular injuries and exsanguination from these injuries is a leading cause of preventable death (Starnes et al 2006). Patients who present definitive signs of vascular injury such as hemorrhage, shock, absent distal pulses, limb ischemia, and/or an expanding pulsatile hematoma require immediate treatment (Britt et al 2001).…”

Section: Introductionmentioning

confidence: 99%

Pulsatile Flow Phantom for Ultrasound Image-Guided HIFU Treatment of Vascular Injuries

Greaby

Zderic

Vaezy

2007

Ultrasound in Medicine & Biology

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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 monitor the HIFU treatment. Triphasic blood flows present in the human arteries were reproduced, with flow rates of 50-500 ml/min, pulse rates of 62-138 beats/min, and peak pressures of 100-250 mmHg. 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. Histological 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 imageguided HIFU application in hemostasis of a variety of blood vessel injuries.

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“…Неконтро-лируемое кровотечение на поле боя было признано самой значительной угрозой жизни солдат за всю историю войн [1]. Травмы магистральных сосудов с массивным кровотечением составляют в среднем до 50 % общей летальности в боевых условиях и 31 % -в мирное время [2,3].…”

Section: Original Researches оригинальные исследованияunclassified

“…И если ситуация продолжает развиваться, то без эффективного вмешательства она перерастает в неконтролируемый геморрагический шок [3,4]. Помимо этого, кровотечение приводит к нарас-танию гипотермии, метаболического ацидоза с нарушением системы свертывания крови, что, в свою очередь, делает гемостаз более сложным [5].…”

Section: Original Researches оригинальные исследованияunclassified

“…Чем раньше будут приняты первичные меры, тем быстрее может быть начато целевое лечение и достигнуты лучшие результаты [6]. Согласно концепции «damage control», контроль за кровотечением на догоспитальном этапе может снизить заболеваемость, о чем также свидетельству-ют опубликованные данные военных источников Соединенных Штатов [1,3,4]. В очерках войны во Вьетнаме, а затем и кампаний в Ираке и Афганиста-не сообщалось, что около 9 % смертей, вызванных кровотечением из травмированных конечностей, можно было предотвратить эффективным методом гемостаза [1].…”

Section: Original Researches оригинальные исследованияunclassified

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Новий Гемостатичний Бинт На Основі Природного Біополімеру Хітозану

Феськов¹,

Sokolov²,

Soloshenko³

2022

ЕМ

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Кровотеча смертельно небезпечна. Проведення екстреного, ефективного гемостазу є основним завданням при наданні допомоги як у мирному житті, так і в період військових конфліктів. Тому догоспітальна гемостатична допомога повинна надаватися в найкоротший термін. Ефективний гемостатичний матеріал повинен бути доступним в екстреній ситуації, легко наноситися і надійно контролювати кровотечу з великих судин. Таким рішенням може стати вітчизняний гемостатичний бинт на нетканій основі з хітозаном Revul®, який відповідає всім вимогам, що висуваються до даних матеріалів. Гемостатика на основі хітозану при зупинці масивних кровотеч відноситься до першої медичної допомоги за класифікацією НАТО. Тому гемостатичний бинт на хімічній основі (хітозан та ін.), згідно з інструкціями з догляду за пораненими на тактичному рівні (ТССС — Tactical Combat Casualty Саrе, 2009 р.), керівництвом з інтенсивної терапії при травмі на догоспітальному етапі в районі бойових дій (BATLS — Battlefild Advanced Trauma Life Support), включений у сучасну аптечку стандарту НАТО як обов’язковий компонент.

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Extremity Vascular Injuries on the Battlefield: Tips for Surgeons Deploying to War

Abstract: The management of extremity vascular injuries on the modern battlefield presents many unique and demanding challenges to even the most seasoned of surgeons. Preparation goes a long way in overcoming some of the obstacles to seamless patient care.

Cited by 132 publications

References 21 publications

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

A decade of major vascular trauma: Lessons learned from gang and civilian warfare

Pulsatile Flow Phantom for Ultrasound Image-Guided HIFU Treatment of Vascular Injuries

Новий Гемостатичний Бинт На Основі Природного Біополімеру Хітозану

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