Citation

Hornez E, Boddaert G, Baudoin Y, Daban JL, Ollat D, Ramiara P, Bonnet S. Ann. Vasc. Surg. 2015; 29(8): 1656.e7-1656.e12.

Affiliation

Service de chirurgie viscérale et thoracique et Département d'anesthésie réanimation, France.

Copyright

(Copyright © 2015, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1016/j.avsg.2015.04.094

PMID

26362619

Abstract

Vascular injuries from war require an emergency treatment whose objective is to quickly obtain hemostasis and the restoration of arterial flow. In this context of heavy trauma and limited means, damage control surgery is recommended and is based on the use of temporary vascular shunts. We report the management of the simultaneous arrival of two vascular injuries of war in a field hospital. Patient 1 presented a ballistic trauma of the elbow with a section of the humeral artery (Gustillo IIIC). A temporary vascular shunt was set up during the external fixation of the elbow. Final revascularization was carried out and aponevrotomies of the forearm were performed. Patient n°2 had a riddled knee with an open fracture of the femur, an avulsion of the popliteal artery and a hemorrhagic shock. A strategy of damage control surgery was carried out with placing an arterial and venous shunt. Aponevrotomies of the leg were carried out before casting. For the traumatisms of the arteries of the members, the use of shunts is reserved for the lesions of the proximal vessels. The many vascular shunts available have the same performances to restore the arterial flow and prevent secondary thrombosis. The time before the final revascularization depends on the clinical condition of the patient. The value of anticoagulation in these cases was not shown.

Language: en