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 language | English (US) |
|---|---|
| Pages (from-to) | 824-830 |
| Number of pages | 7 |
| Journal | Journal of Trauma - Injury, Infection and Critical Care |
| Volume | 61 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2006 |
Fingerprint
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 journal › Article
}
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 -