Tactical Surgical Intervention with Temporary Shunting of Peripheral Vascular Trauma Sustained during Operation Iraqi Freedom: One Unit's Experience.

摘要

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. Standard Javid or Sundt shunts were placed to temporarily bypass complex peripheral vascular injuries encountered by a forward U.S. Navy surgical unit during a 6-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 U.S. medical centers was retrospectively reviewed once the operating surgeons had returned from deployment. Twenty-seven vascular shunts were used to bypass complex vascular injuries in 20 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.