The Management of Trauma Venous Injury: Civilian and Wartime Experiences

Quan, Reagan; Adams, Eric D.; Cox, Margueritte; Eagleton, Matthew J.; Weber, Michael A.; Fox, Charles J.; Gillespie, David L.

doi:10.1177/1531003506293452

Cited by 27 publications

(19 citation statements)

References 17 publications

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“…Additional recommendations that differ from the treatment of adults included a preference for duplex ultrasonography instead of completion angiography for evaluating the repair, due to the risk of iatrogenic injury to small caliber vessels [18]. Treatment recommendations for venous injury were similar to adults; however, ligation of large venous structures (iliac vein, common femoral vein, and popliteal vein) was discouraged due to the theoretical risk of deep venous thrombosis, although there is no supporting data [18,19].…”

Section: Vascular Repairmentioning

confidence: 99%

Pediatric Combat Trauma

Russo

Neff

2016

Curr Trauma Rep

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Purpose of review Military physicians have amassed tremendous experience treating children with combat-related injuries in Iraq and Afghanistan. This review will present several treatment principles adapted from adult trauma care that were applied to children in war and consider their selective application in civilian practice. Recent findings Many standard practices of adult trauma care were applied to the management of war-injured children. Initial reports of tourniquet use, tranexamic acid administration, and balanced blood transfusion suggest a benefit to the pediatric population. Constraints of providing intensive care in an austere environment required a shift in management toward aggressive limb salvage over amputation, and early palliation for severe brain injury or extensive burns.Summary Despite the obstacles that may limit the direct translation of trauma care principals to civilian settings, these wartime experiences offer robust and excellent preliminary data that might inform future investigations in the field of pediatric trauma care.

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Section: Vascular Repairmentioning

confidence: 99%

Pediatric Combat Trauma

Russo

Neff

2016

Curr Trauma Rep

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“…On his return to the United States, he established the Vietnam Vascular Registry, which has records from more than 7500 cases and still is used today [117,147].…”

Section: Surgical Techniques and Technologymentioning

confidence: 99%

Treatment of War Wounds: A Historical Review

Manring

Hawk

Calhoun

et al. 2009

Clinical Orthopaedics &Amp; Related Research

142

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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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“…Our groups in particular have discussed potential benefits of restoration of venous continuity. [5][6]16 Moreover, there is no appreciable increased risk of thromboembolism with venous repair, providing further evidence supporting this strategy. 15 In our cohort, several individuals had vein disruption shunted early in the course of injury.…”

Section: Discussionmentioning

confidence: 94%

“…Individual registries in OIF have reported early amputation rates of 5% to 10% [5][6][7][8] as opposed to 50% in World War II 9 and 10% to 20% for Korea and Vietnam. [10][11][12][13][14] Yet, current in-theater descriptions of TVS, 2-4 venous injury repair, 5,15,16 and other employed treatment maneuvers allude only to technical considerations and immediate, or early limb salvage and fail to include long term outcomes or risk analysis.…”

mentioning

confidence: 99%

Effect of temporary shunting on extremity vascular injury: An outcome analysis from the Global War on Terror vascular injury initiative

Gifford

Aidinian

Clouse

et al. 2009

Journal of Vascular Surgery

141

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Temporary vascular shunting used as a damage control adjunct in management of wartime extremity vascular injury does not lead to worse outcomes. Benefit from TVS is suggested, but not statistically significant. Injury specific variables of venous ligation, associated fracture, and penetrating blast mechanism are associated with amputation. Amputation-free survival after vascular injury in Operation Iraqi Freedom is 79% at three years. Further studies to statistically define any possible benefits of TVS are needed.

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The Management of Trauma Venous Injury: Civilian and Wartime Experiences

Cited by 27 publications

References 17 publications

Pediatric Combat Trauma

Pediatric Combat Trauma

Treatment of War Wounds: A Historical Review

Effect of temporary shunting on extremity vascular injury: An outcome analysis from the Global War on Terror vascular injury initiative

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