Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom: One unit's experience

Lowell W. Chambers, D. J. Green, Kenneth Sample, Bruce L. Gillingham, Peter Rhee, Carlos Brown, Nalan Narine, John M. Uecker, Harold R. Bohman

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

BACKGROUND: Rapidly restoring perfusion to injured extremities is one of the primary missions of forward military surgical teams. The austere setting, limited resources, and grossly contaminated nature of wounds encountered complicates early definitive repair of complex combat vascular injuries. Temporary vascular shunting of these injuries in the forward area facilitates rapid restoration of perfusion while allowing for deferment of definitive repair until after transport to units with greater resources and expertise. METHODS: Standard Javid or Sundt shunts were placed to temporarily bypass complex peripheral vascular injuries encountered by a forward US Navy surgical unit during a six month interval of Operation Iraqi Freedom. Data from the time of injury through transfer out of Iraq were prospectively recorded. Each patient's subsequent course at Continental US medical centers was retrospectively reviewed once the operating surgeons had returned from deployment. RESULTS: Twenty-seven vascular shunts were used to bypass complex vascular injuries in twenty combat casualties with a mean injury severity score of 18 (range 9-34) and mean mangled extremity severity score of 9 (range 6-11). All patients survived although three (15%) ultimately required amputation for nonvascular complications. Six (22%) shunts clotted during transport but an effective perfusion window was provided even in these cases. CONCLUSION: Temporary vascular shunting appears to provide simple and effective means of restoring limb perfusion to combat casualties at the forward level.

Original languageEnglish (US)
Pages (from-to)824-830
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume61
Issue number4
DOIs
StatePublished - Oct 2006

Fingerprint

2003-2011 Iraq War
Vascular System Injuries
Blood Vessels
Perfusion
Extremities
Wounds and Injuries
Iraq
Injury Severity Score
Amputation

Keywords

  • Combat
  • Forward surgery
  • Military
  • Vascular

ASJC Scopus subject areas

  • Surgery

Cite this

Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom : One unit's experience. / Chambers, Lowell W.; Green, D. J.; Sample, Kenneth; Gillingham, Bruce L.; Rhee, Peter; Brown, Carlos; Narine, Nalan; Uecker, John M.; Bohman, Harold R.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 61, No. 4, 10.2006, p. 824-830.

Research output: Contribution to journalArticle

Chambers, Lowell W. ; Green, D. J. ; Sample, Kenneth ; Gillingham, Bruce L. ; Rhee, Peter ; Brown, Carlos ; Narine, Nalan ; Uecker, John M. ; Bohman, Harold R. / Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom : One unit's experience. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 61, No. 4. pp. 824-830.
@article{86a4538b959b42e09648035d324f933a,
title = "Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom: One unit's experience",
abstract = "BACKGROUND: Rapidly restoring perfusion to injured extremities is one of the primary missions of forward military surgical teams. The austere setting, limited resources, and grossly contaminated nature of wounds encountered complicates early definitive repair of complex combat vascular injuries. Temporary vascular shunting of these injuries in the forward area facilitates rapid restoration of perfusion while allowing for deferment of definitive repair until after transport to units with greater resources and expertise. METHODS: Standard Javid or Sundt shunts were placed to temporarily bypass complex peripheral vascular injuries encountered by a forward US Navy surgical unit during a six month interval of Operation Iraqi Freedom. Data from the time of injury through transfer out of Iraq were prospectively recorded. Each patient's subsequent course at Continental US medical centers was retrospectively reviewed once the operating surgeons had returned from deployment. RESULTS: Twenty-seven vascular shunts were used to bypass complex vascular injuries in twenty combat casualties with a mean injury severity score of 18 (range 9-34) and mean mangled extremity severity score of 9 (range 6-11). All patients survived although three (15{\%}) ultimately required amputation for nonvascular complications. Six (22{\%}) shunts clotted during transport but an effective perfusion window was provided even in these cases. CONCLUSION: Temporary vascular shunting appears to provide simple and effective means of restoring limb perfusion to combat casualties at the forward level.",
keywords = "Combat, Forward surgery, Military, Vascular",
author = "Chambers, {Lowell W.} and Green, {D. J.} and Kenneth Sample and Gillingham, {Bruce L.} and Peter Rhee and Carlos Brown and Nalan Narine and Uecker, {John M.} and Bohman, {Harold R.}",
year = "2006",
month = "10",
doi = "10.1097/01.ta.0000197066.74451.f3",
language = "English (US)",
volume = "61",
pages = "824--830",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom

T2 - One unit's experience

AU - Chambers, Lowell W.

AU - Green, D. J.

AU - Sample, Kenneth

AU - Gillingham, Bruce L.

AU - Rhee, Peter

AU - Brown, Carlos

AU - Narine, Nalan

AU - Uecker, John M.

AU - Bohman, Harold R.

PY - 2006/10

Y1 - 2006/10

N2 - BACKGROUND: Rapidly restoring perfusion to injured extremities is one of the primary missions of forward military surgical teams. The austere setting, limited resources, and grossly contaminated nature of wounds encountered complicates early definitive repair of complex combat vascular injuries. Temporary vascular shunting of these injuries in the forward area facilitates rapid restoration of perfusion while allowing for deferment of definitive repair until after transport to units with greater resources and expertise. METHODS: Standard Javid or Sundt shunts were placed to temporarily bypass complex peripheral vascular injuries encountered by a forward US Navy surgical unit during a six month interval of Operation Iraqi Freedom. Data from the time of injury through transfer out of Iraq were prospectively recorded. Each patient's subsequent course at Continental US medical centers was retrospectively reviewed once the operating surgeons had returned from deployment. RESULTS: Twenty-seven vascular shunts were used to bypass complex vascular injuries in twenty combat casualties with a mean injury severity score of 18 (range 9-34) and mean mangled extremity severity score of 9 (range 6-11). All patients survived although three (15%) ultimately required amputation for nonvascular complications. Six (22%) shunts clotted during transport but an effective perfusion window was provided even in these cases. CONCLUSION: Temporary vascular shunting appears to provide simple and effective means of restoring limb perfusion to combat casualties at the forward level.

AB - BACKGROUND: Rapidly restoring perfusion to injured extremities is one of the primary missions of forward military surgical teams. The austere setting, limited resources, and grossly contaminated nature of wounds encountered complicates early definitive repair of complex combat vascular injuries. Temporary vascular shunting of these injuries in the forward area facilitates rapid restoration of perfusion while allowing for deferment of definitive repair until after transport to units with greater resources and expertise. METHODS: Standard Javid or Sundt shunts were placed to temporarily bypass complex peripheral vascular injuries encountered by a forward US Navy surgical unit during a six month interval of Operation Iraqi Freedom. Data from the time of injury through transfer out of Iraq were prospectively recorded. Each patient's subsequent course at Continental US medical centers was retrospectively reviewed once the operating surgeons had returned from deployment. RESULTS: Twenty-seven vascular shunts were used to bypass complex vascular injuries in twenty combat casualties with a mean injury severity score of 18 (range 9-34) and mean mangled extremity severity score of 9 (range 6-11). All patients survived although three (15%) ultimately required amputation for nonvascular complications. Six (22%) shunts clotted during transport but an effective perfusion window was provided even in these cases. CONCLUSION: Temporary vascular shunting appears to provide simple and effective means of restoring limb perfusion to combat casualties at the forward level.

KW - Combat

KW - Forward surgery

KW - Military

KW - Vascular

UR - http://www.scopus.com/inward/record.url?scp=33750029312&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750029312&partnerID=8YFLogxK

U2 - 10.1097/01.ta.0000197066.74451.f3

DO - 10.1097/01.ta.0000197066.74451.f3

M3 - Article

C2 - 17033547

AN - SCOPUS:33750029312

VL - 61

SP - 824

EP - 830

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -