Vascular Surgery in World War II

Cherry, Kenneth J.; Rich, Norman M.

doi:10.1097/sla.0000000000001181

Cited by 15 publications

(7 citation statements)

References 11 publications

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“…12 As operative approach transitioned from ligation to revascularization at the conclusion of World War II and the beginning of the Korean War, amputations markedly declined with recent civilian series reporting limb loss rates of only 3%. [13][14][15][16] Although outcomes have improved in patients with isolated long bone fracture and major vascular injuries of the extremity, they remain especially morbid diagnoses when presenting simultaneously in the same extremity. In these patients amputation and mortality rates remain as high as 36% and 7%, respectively, highlighting the added complexity of patients with combined vascular and orthopedic injuries and underscoring the role that operative sequence and timing may play in optimizing outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, extremity arterial injuries conferred significant morbidity with amputation rates greater than 40% reported during the Second World War 12 . As operative approach transitioned from ligation to revascularization at the conclusion of World War II and the beginning of the Korean War, amputations markedly declined with recent civilian series reporting limb loss rates of only 3% 13–16 . Although outcomes have improved in patients with isolated long bone fracture and major vascular injuries of the extremity, they remain especially morbid diagnoses when presenting simultaneously in the same extremity.…”

Section: Discussionmentioning

confidence: 99%

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Timing is everything: Impact of combined long bone fracture and major arterial injury on outcomes

Lewis

Perkins

Fischer

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND Timing of extremity fracture fixation in patients with an associated major vascular injury remains controversial. Some favor temporary fracture fixation before definitive vascular repair to limit potential graft complications. Others advocate immediate revascularization to minimize ischemic time. The purpose of this study was to evaluate the timing of fracture fixation on outcomes in patients with concomitant long bone fracture and major arterial injury. METHODS Patients with a combined long bone fracture and major arterial injury in the same extremity requiring operative repair over 11 years were identified and stratified by timing of fracture fixation. Vascular-related morbidity (rhabdomyolysis, acute kidney injury, graft failure, extremity amputation) and mortality were compared between patients who underwent fracture fixation prerevascularization (PRE) or postrevascularization (POST). RESULTS One hundred four patients were identified: 19 PRE and 85 POST. Both groups were similar with respect to age, sex, Injury Severity Score, admission base excess, 24-hour packed red blood cells, and concomitant venous injury. The PRE group had fewer penetrating injuries (32% vs. 60%, p = 0.024) and a longer time to revascularization (9.5 vs. 5.8 hours, p = 0.0002). Although there was no difference in mortality (0% vs. 2%, p > 0.99), there were more vascular-related complications in the PRE group (58% vs. 32%, p = 0.03): specifically, rhabdomyolysis (42% vs. 19%, p = 0.029), graft failure (26% vs. 8%, p = 0.026), and extremity amputation (37% vs. 13%, p = 0.013). Multivariable logistic regression identified fracture fixation PRE as the only independent predictor of graft failure (odds ratio, 3.98; 95% confidence interval, 1.11–14.33; p = 0.03) and extremity amputation (odds ratio, 3.924; 95% confidence interval, 1.272–12.111; p = 0.017). CONCLUSION Fracture fixation before revascularization contributes to increased vascular-related morbidity and was consistently identified as the only modifiable risk factor for both graft failure and extremity amputation in patients with a combined long bone fracture and major arterial injury. For these patients, delaying temporary or definitive fracture fixation until POST should be the preferred approach. LEVEL OF EVIDENCE Prognostic study, Level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Timing is everything: Impact of combined long bone fracture and major arterial injury on outcomes

Lewis

Perkins

Fischer

et al. 2021

J Trauma Acute Care Surg

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“…Ever since the late stages of World War II, where ligation of arteries and veins was the treatment of choice, surgical and technical abilities have evolved towards a diversified armamentarium, significantly increasing limb salvage and survival rates, nowadays enabling individualized care [29, 30]. Especially rapid endovascular repair for bleeding control has evolved as primary option for certain clinical entities of vascular injury, like embolization in pelvic bleeding, stentgraft implantation in aortic transection or thoracic outlet vessel breach [22, 25, 31, 32].…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

Gilbert

Schneemann

Scholz

et al. 2018

BMC Musculoskelet Disord

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BackgroundVascular damage in polytrauma patients is associated with high mortality and morbidity. Therefore, specific clinical implications of vascular damage with fractures in major trauma patients are reassessed.MethodsThis comprehensive nine-year retrospective single center cohort study analyzed demography, laboratory, treatment and outcome data from 3689 patients, 64 patients with fracture-associated vascular injuries were identified and were compared to a control group.Results: Vascular damage occurred in 7% of patients with upper and lower limb and pelvic fractures admitted to the trauma room. Overall survival was 80% in pelvic fracture and 97% in extremity fracture patients and comparable to non-vascular trauma patients. Additional arterial damage required substantial fluid administration and was visible as significantly anemia and disturbed coagulation tests upon admission. Open procedures were done in over 80% of peripheral extremity vascular damage. Endovascular procedures were predominant (87%) in pelvic injury.ConclusionVascular damage is associated with high mortality rates especially in combination with pelvic fractures. Initial anemia, disturbed coagulation tests and the need for extensive pre-clinical fluid substitution were observed in the cohort with vascular damage. Therefore, fast diagnosis and early interventional and surgical procedures are necessary to optimize patient-specific outcome.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2333-y) contains supplementary material, which is available to authorized users.

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“…In the continental United States, the Army Surgeon General created specialty hospitals in orthopedics, spine injuries, ophthalmic problems, renal disorders and other fields. 141 Relaying the specific developments in GSW management for each specialty remains outside the scope of this article, but these centers highlighted the advantages and promise of focusing intellectual and technological resources on particular problems. The number of disfigured casualties from the World Wars also catalyzed the expansion of new disciplines dedicated to rehabilitation.…”

Section: The Second World War and Beyondmentioning

confidence: 99%

‘Through and Through’ History: The Management of Gunshot Wounds From the 14th Century to the Present

Schalick

Horn

Marble

et al. 2023

Annals of Surgery Open

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Gun violence killed over 46,000 Americans in 2021; almost 120,000 suffered gunshot wounds. This epidemic has attracted national attention and increasing concern from medical and surgical organizations, as evident in this special issue. ‘Through and Through History’ explores the surgical management of gunshot wounds from their earliest appearance in 14th-century Europe to the present. Interweaving the civilian and military experience, it details not only the evolution of care directly applied to patients but also the social, political, and scientific milieu that shaped decisions made and actions performed both in and out of the operating room. The article describes how surgeons have pushed the boundaries of medicine and science in each era, developing new therapies for their patients, a historical trend that persists today when such care has the potential to save tens of thousands of lives each year.

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Vascular Surgery in World War II

Cited by 15 publications

References 11 publications

Timing is everything: Impact of combined long bone fracture and major arterial injury on outcomes

Timing is everything: Impact of combined long bone fracture and major arterial injury on outcomes

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma

‘Through and Through’ History: The Management of Gunshot Wounds From the 14th Century to the Present

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