Accession Number:

ADA629594

Title:

Long-Term Follow-Up and Amputation-Free Survival in 497 Casualties with Combat-Related Vascular Injuries and Damage-Control Resuscitation

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2012-01-01

Pagination or Media Count:

9.0

Abstract:

BACKGROUND The effectiveness of damage-control resuscitation DCR has been demonstrated in recent US conflicts. Wartime casual-ties treated for hemorrhagic shock from vascular wounds were studied to report the 24-hour transfusion requirements, graft patency, and amputation-free survival for major vascular injuries. METHODS Joint Theater Trauma Registry data from August 2006 to April 2011 56 months were retrospectively reviewed. Included were casualties with a vascular injury who presented to US combat support hospitals in Iraq or Afghanistan. Amputation-free survival and graft patency were determined from record and imaging review. RESULTS The study group consisted of 497 severely wounded local national and military casualties mean SD Injury Severity Score ISS, 17 8.5 presenting with acidosis pH 7.29 0.15, tachycardia heart rate, 110 29.31, and coagulopathy international normalized ratio, 1.6 2.33. Given DCR and early management of vascular injury, blood pressure, heart rate, temperature, hemoglobin, and base deficit improved promptly p less than 0.05 by intensive care unit admission. Transfusion requirements included packed red blood cells 15 13 U range, 1 70 U, fresh frozen plasma 14 13 U range, 1 72 U, cryoprecipitate 13 15 U range, 1 49 U, and platelets 8 6 U range, 1 36 U. Mean operative time was 232 minutes range, 16 763 minutes. US casualties n 111 had limb salvage attempted for 113 extremity vascular injuries 3 2 iliac, 33 30 femoral, 23 20 popliteal, 13 12 tibial, 33 30 brachial, 4 3 ulnar, and 4 3 radial. In this sub- group, 28 25 were revascularized by a primary repair or end anastomosis, 80 71 were revascularized by saphenovenous grafts, and 5 4 were revascularized by prosthetic grafts.

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research
  • Military Forces and Organizations

Distribution Statement:

APPROVED FOR PUBLIC RELEASE