Infektionsprophylaxe bei Kriegsverletzungen

Czymek, Ralf; Lenz, S.; Düsel, W.

doi:10.1007/s001040050879

Cited by 11 publications

(5 citation statements)

References 16 publications

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“…Infection prophylaxis, including intraoperative and short postoperative (2 to 3 days) I.V. infusion of broad-spectrum antibiotics, is internationally accepted for reduction of septic complications [4,29].…”

Section: Discussionmentioning

confidence: 99%

“…Modernization of emergency transport systems has shortened the time interval between the trauma and hospital admission. For example, during World War I this interval was 12 to 18 hours, and in the Vietnam war it was reduced to 2 hours [4].…”

Section: Discussionmentioning

confidence: 99%

“…According to different publications, 40% to 70% of all war trauma is localized on extremities [4][5][6]. Gunshot wounds to the upper limbs result in significant long-term morbidity, although the mortality rate for isolated injuries is low [7].…”

mentioning

confidence: 99%

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War Injuries of Major Extremity Arteries

et al. 2003

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During the period 1991-1994, 99 patients (all males, median age 35 years) with combat-related injuries of major limb arteries were managed. Mechanism: mine fragments (40%), high-velocity projectiles (35%), and shotgun pellets (25%). Patients were admitted 1 hour to 16 hours (median 8 hours) after injury; 39% were in severe hemorrhagic shock. Arterial injury was diagnosed by clinical findings. Preoperative angiography was usually not necessary. Of 99 injured patients, 50 (51%) showed signs of distal ischemia and required arterial reconstruction. No primary amputation was performed. Reconstruction was always necessary in cases of injury of axillary or popliteal arteries, but not of superficial femoral or brachial arteries. Ligation of injured single forearm or crural arteries was well tolerated. End-to-end anastomosis by reconstruction was possible only in 38% of cases. In 56% of patients, autologous venous bypass was performed. Uncontrolled wound infection developed in 22% of cases, leading to a secondary hemorrhage compelling arterial ligature (8%), and thrombosis (6%). The secondary amputation rate after arterial reconstruction was 10%. Injury of major vessels was associated with limb bone fractures, nerve damage, or major vein injuries in 68% of cases, frequently on the forearm, the popliteal region, and the crural region. When limb ischemia was present, vascular reconstruction had priority over orthopedic immobilization. Arterial injury was almost always associated with the venous damage in the forearm, the popliteal region, and the crural region. Injured veins of the upper limb were ligated; venous repair was more often indicated in lower limb injury (52%). The method of choice was lateral suture/patch. Gunshot damage to peripheral nerves was rarely treated with primary repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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War Injuries of Major Extremity Arteries

et al. 2003

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“…So ste hen fol gerich tig die gro ßen Ge fäße vor den Pa renchym blu tun gen der Ab do mi nal or ga ne und vor der Ver sor gung ver letz ter Hohl or ga ne. Die Sin gle-shot-An ti bio ti ka pro phy la xe ist Stan dard [4]. Der Zu gang er folgt über eine me dia ne La paro to mie, die in eine Tho rako to mie er wei tert wer den kann.…”

Section: All Ge Mei Nesunclassified

Penetrierendes Bauchtrauma aus der Sicht der Bundeswehr

Düsel

Lieber

Lenz

et al. 2005

Chirurg

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On military missions abroad, surgical care for penetrating abdominal injuries differentiates from that given at home. The different conditions in the field usually include a single general surgeon with no further specialists or hospitals to rely upon. Thus a mismatch between treatment capacity and needs can be experienced in mass casualty situations. Therefore the focus is on damage control surgery, getting patients fit for evacuation, and transport home under intensive care if needed. Knowledge of ballistics and explosive devices are adjunct fields of interest, as they improve the understanding and treatment of military injuries. Although these aspects add up to additional training requirements to be met by our surgeons, we are convinced that the new German education standards will allow successful training of future military surgeons.

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“…These are the rates of infection reported in civilian injuries; the rates of infection for combat casualties are likely to be higher due to delays before treatment, the predominance of penetrating trauma, and overall poor sanitation. 7 The victim should receive immediate, formal wound exploration, irrigation, debridement, and fracture stabilization in the operating room. In view of these considerations, rapid transport to a definitive care facility should be urged.…”

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confidence: 99%

Prehospital Care of Orthopedic Injuries

Melamed

Blumenfeld

Kalmovich

et al. 2007

Prehosp. Disaster med.

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Orthopedic injuries are predominant among combat casualties, and carry the potential for significant morbidity. An expert consensus process (Prehospital care of military orthopedic trauma: A consensus meeting, Israel Defense Forces Medical Corps, May 2003) was used to create guidelines for the treatment of these injuries by military prehospital providers. The consensus treatment guidelines developed by experienced orthopedic trauma personnel from leading trauma centers in Israel are presented in this paper.For victims with open fractures, the first priority is hemorrhage control. Splinting, irrigation, and wound care should be performed while waiting for transport, or, in any scenario, in the case of an isolated limb injury. The use of traction splints was advocated for both the rapid transport scenario (up to one hour from the time of injury to arrival at the hospital) and the delayed transport scenario. In the urban setting, traction splints may not be necessary. Any victim experiencing pelvic pain following a high-energy mechanism of injury should be presumed to have an unstable pelvic fracture, and a sheet should be tied around the pelvis. The panel agreed that field-reduction of dislocations should be avoided by the medical officer unless it is anticipated that the patient will need to go through a long evacuation chain and the medical officer is familiar with specific reduction techniques.

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Infektionsprophylaxe bei Kriegsverletzungen

Cited by 11 publications

References 16 publications

War Injuries of Major Extremity Arteries

War Injuries of Major Extremity Arteries

Penetrierendes Bauchtrauma aus der Sicht der Bundeswehr

Prehospital Care of Orthopedic Injuries

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