| Long-term follow-up and amputation-free survival in 497 casualties with combat-related vascular injuries and damage-control resuscitation. | |
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MedLine Citation:
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PMID: 23188245 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: The effectiveness of damage-control resuscitation (DCR) has been demonstrated in recent US conflicts. Wartime casualties 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 < 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 subgroup, 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. The follow-up ranged from 29 days to 1,079 days, (mean, 347 days), during which 96 grafts (84.9%) remained patent, 16 casualties (14.2%) required a delayed amputation, and 110 (99.1%) survived. Popliteal injuries had the highest amputation rate (7 of 23, 30.4%). The amputation-free survival was 84%. CONCLUSION: In severely wounded casualties, wartime surgical strategies to save both life and limb evidently permit definitive procedures at initial surgery with excellent limb salvage results. This outcome analysis in a large cohort can help to refine surgical judgment and support contemporary DCR practices for major vascular injury. LEVEL OF EVIDENCE: Epidemiologic study, level III; therapeutic study, level V. |
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Authors:
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Anahita Dua; Bhavin Patel; John F Kragh; John B Holcomb; Charles J Fox |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The journal of trauma and acute care surgery Volume: 73 ISSN: 2163-0763 ISO Abbreviation: J Trauma Acute Care Surg Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-11-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101570622 Medline TA: J Trauma Acute Care Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1515-20 Citation Subset: AIM; IM |
Affiliation:
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From the Division of Vascular Surgery (C.J.F.), Department of Surgery (A.D., B.P.), Walter Reed National Military Medical Center; Norman M. Rich Department of Surgery (C.J.F.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; US Army Institute of Surgical Research (J.F.K), Fort Sam Houston; Division of Acute Care Surgery (J.B.H.), Department of Surgery, University of Texas Health Science Center, Houston, Texas. |
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