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Engelhardt M, Schmid R, Kölbel B, Hyhlik-Dürr A, Zerwes S, Zischek C. Training in vascular trauma surgery for non-vascular surgeons: Vascular trauma surgery skills course. Eur Surg 2023; 55:89-93. [PMID: 37206194 PMCID: PMC10123566 DOI: 10.1007/s10353-023-00800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Background The experience of general and trauma surgeons in vascular trauma management has decreased with sub-specialization of surgery and working hours restrictions. We introduce a vascular trauma surgery skills course established to train German military surgeons prior to their deployment to conflict areas. Methods The intention and implementation of the vascular trauma course for non-vascular surgeons is described in detail. Results In hands-on courses, participants learn and train basic vascular surgical techniques on more realistic extremity, neck, and abdominal models with pulsatile vessels. A fundamental and an advanced course each provide military as well as civilian surgeons from different non-vascular specialties with a surgical skill set including direct vessel sutures, patch angioplasty, anastomosis, thrombectomy, and resuscitative endovascular balloon occlusion of the aorta (REBOA) in order to render them capable of managing major vascular injuries. Conclusion The experiences of this vascular trauma surgical skills course, initially established for military surgeons, can also be of use to all civilian general, visceral, and trauma surgeons occasionally facing traumatic or iatrogenic vascular injuries. Thus, the introduced vascular trauma course is valuable for all surgeons working in trauma centers.
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Affiliation(s)
- M. Engelhardt
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - R. Schmid
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - B. Kölbel
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - A. Hyhlik-Dürr
- Medical Faculty, University of Augsburg, Augsburg, Germany
| | - S. Zerwes
- Medical Faculty, University of Augsburg, Augsburg, Germany
| | - C. Zischek
- Department of Vascular and Endovascular Surgery, Centre for Vascular Medicine, Military Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
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Carotide-jugular fistula due to vascular trauma with chain saw. Diagnostic and surgical approach. ANGIOLOGIA 2020. [DOI: 10.20960/angiologia.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Soares LT, Bastos CC, Koury Junior A, Pereira AJF. Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.
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Krüger A, Florido C, Braunisch A, Walther E, Yilmaz TH, Doll D. Penetrating arterial trauma to the limbs: outcome of a modified protocol. World J Emerg Surg 2013; 8:51. [PMID: 24305415 PMCID: PMC4176145 DOI: 10.1186/1749-7922-8-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background Penetrating arterial injuries to the limbs are common injuries in high volume trauma centers. Their overall surgical results reported in the literature are satisfactory - apart of those of the popliteal artery that still may lead to a significant incidence in amputations. With the present study we assessed our outcome with penetrating arterial injuries to the limb as to see if the direct involvement of vascular surgeons in the management of popliteal artery injuries leads to an improved (lowered) amputation rate. Results were benchmarked with our published results from previous years. Methods All patients sustaining penetrating arterial injuries to the limbs admitted to the Chris Hani Baragwanath Academic Hospital during an 18- month period ending in September 2011 were included in this study. Axillary, brachial and femoral artery injuries were operated on by the trauma surgeons as in the past. All popliteal artery injuries were operated on by the vascular surgeons (new). Results There were a total of 113 patients with 116 injuries, as some patients had multiple vascular injuries: 10 axillary, 47 brachial, 34 femoral and 25 popliteal artery injuries. Outcome of axillary, brachial and femoral artery injury repair were excellent and not significantly different from our previous reported experience. Injury to the popliteal artery showed a diminished re-exploration rate from 34% down to 10% (p = 0,049) and a decrease of amputation rate from 16% to 11% which was statistically not significant (p = 0,8). Conclusion Penetrating arterial trauma to the axillary, brachial and femoral artery is followed by excellent results when operated by trauma surgeons. In the case of popliteal artery injury operated by the vascular surgeons, the results of this study do not show any statistically significant difference related to amputation rate from our previous reported studies when operated by trauma surgeons. Taking into consideration the diminished re-exploration rate and a tendency to a lower amputation rate, we feel that there is possible tendency of better outcome if operated by vascular surgeons. Multicenter studies with large number of enrolled patients will be required to prove the validity of this suggestion.
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Affiliation(s)
- Antonio Krüger
- Department of Trauma-, Hand- and Reconstructive Surgery, Philipps-University, Baldingerstr, 1, Marburg, Germany.
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Western Trauma Association critical decisions in trauma: management of the mangled extremity. J Trauma Acute Care Surg 2012; 72:86-93. [PMID: 22310120 DOI: 10.1097/ta.0b013e318241ed70] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The operative management of mangled extremities after trauma remains controversial. We have sought to develop an evidence-based algorithm to help guide practitioners when faced with these relatively infrequent but very challenging clinical dilemmas. METHODS The Western Trauma Association Critical Decisions Committee queried the literature to identify high-quality managements that would help guide the care of mangled extremities. When good data were not available, the Committee relied on expert opinions, either from the literature or from our senior members. RESULTS Virtually, all the scoring systems used to guide therapy have not been proven to be valid. Hemodynamically unstable patients who failed to respond to initial resuscitation should be taken to the operating room for exploration and vascular control. Those who are stable should undergo a stepwise vascular and neurologic evaluation process. A comprehensive evaluation of factors that may help predict the appropriateness of limb salvage should be done in the operating room. Patients who are not candidates for salvage should undergo primary amputation. Those who are should undergo attempts at limb salvage. CONCLUSIONS Patients with mangled extremities remain a significant management challenge. This algorithm represents a guideline based on the best evidence available in the literature and expert opinion. It does not establish a standard of care. It should provide a framework for treating physicians and other healthcare professionals to guide therapy, considering individual patients' clinical status and institutional resources.
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Cristián Salas D. Trauma vascular, visión del cirujano vascular. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Schuurman N, Cinnamon J, Matzopoulos R, Fawcett V, Nicol A, Hameed SM. Collecting injury surveillance data in low- and middle-income countries: the Cape Town Trauma Registry pilot. Glob Public Health 2011; 6:874-89. [PMID: 20938854 DOI: 10.1080/17441692.2010.516268] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data. We describe a hospital-based trauma surveillance instrument for collection of a minimum data-set for calculating common injury scoring metrics including the Abbreviated Injury Scale and the Injury Severity Score. The Cape Town Trauma Registry (CTTR) is designed for injury surveillance in low-resource settings. A pilot at Groote Schuur Hospital in Cape Town was conducted for one month to demonstrate the feasibility of systematic data collection and analysis, and to explore challenges of implementing a trauma registry in a LMIC. Key characteristics of the CTTR include: ability to calculate injury severity, key minimal data elements, expansion to include quality indicators and minimal drain on human resources based on few fields. The CTTR provides a strategy to describe the distribution and consequences of injury in a high trauma volume, low-resource environment.
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Affiliation(s)
- Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Chapellier X, Sockeel P, Baranger B. Management of penetrating abdominal vessel injuries. J Visc Surg 2010; 147:e1-12. [DOI: 10.1016/j.jviscsurg.2010.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Degiannis E, Loukogeorgakis SP, Glapa M, Doll D. [Operative management of penetrating injuries to the subclavian artery. Technical tutorial]. Chirurg 2008; 79:560-3. [PMID: 18209991 DOI: 10.1007/s00104-007-1451-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Penetrating injury to the subclavian arteries is one of the most taxing arterial injuries a trauma surgeon can encounter. Operative access for repair is difficult, crossing two separate anatomical areas-superior mediastinum and base of the neck. The artery runs well protected behind sternum and clavicle and tears easily if clamped. Physiologically unstable patients must be rushed to theatre in an attempt to control exanguinating haemorrhage and to repair the injury. In the rare circumastance of being confronted with it, it is imperative for the occasional trauma surgeon to have a practical operative concept for dealing with this type of injury. This tutorial describes a practical approach for penetrating subclavian injuries, and it discusses alternative surgical strategies when supraclavicular expanding hematomas deny straightforward access.
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Affiliation(s)
- E Degiannis
- Directorate of Trauma and Burns, Department of Surgery, Chris Hani Baragwanath Hospital, University of Witwatersrand Medical School, Johannesburg, Südafrika
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Degiannis E, Bowley DM, Bode F, Lynn WR, Glapa M, Baxter S, Shapey J, Smith MD, Doll D. Ballistic Arterial Trauma to the Lower Extremity: Recent South African Experience. Am Surg 2007. [DOI: 10.1177/000313480707301112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the current outcome of gunshots to the arteries of the lower extremity. The authors conducted a retrospective analysis of 104 patients with gunshots to the femoral (n = 71) and popliteal (n = 33) artery. One hundred four patients presented over the 60-month period. Ninety-six (92%) were male and eight of 104 female. Ninety-nine were gunshot injuries, five from shotguns. Nine patients had injury to the common femoral artery, 62 patients had injury to the superficial femoral artery, and 33 had popliteal artery injury. One patient died in the emergency room and another died in the postoperative period, giving an overall in-hospital mortality of two of 104 (1.9%). Forty-three of 70 femoral reconstructions had completion angiograms compared with 20 of 32 popliteal artery reconstructions ( P = 1). Nineteen of 63 (30%) of the completion angiograms prompted revision of the reconstruction. Of the 63 patients who had completion angiograms, two of 63 (3%) required amputation. Seven of 39 (18%) patients who did not have completion angiograms required amputation ( P = 0.025). Including the primary amputation, there were 10 amputations in the 103 patients (9.7%) who survived to undergo operation. Ballistic arterial trauma of the lower limb leads to significant disability. Completion arteriography leads to revision of the reconstruction in nearly one-third of instances and significantly reduces amputation rate.
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Affiliation(s)
- Elias Degiannis
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Douglas M. Bowley
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Frank Bode
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - William R. Lynn
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Miriam Glapa
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Shaun Baxter
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - James Shapey
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Martin D. Smith
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
| | - Dietrich Doll
- Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa
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Rai KM, Mohanty SK, Kale R, Chakrabarty A, Prasad D. Management of Vascular Injuries in a Forward Hospital. Med J Armed Forces India 2006; 62:246-51. [PMID: 27365688 PMCID: PMC4922881 DOI: 10.1016/s0377-1237(06)80012-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2001] [Accepted: 05/05/2006] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Management of vascular injuries poses a challenging problem under warlike conditions. Several authorities recommend limb revascularisation only within first 6-8 hours, as the outcome after delayed revascularisation is poor. METHODS A retrospective analysis of 61 consecutive patients with vascular injury in a forward hospital over a 25- month period was carried out. RESULTS Vascular injuries constituted 3.1% of all injuries. The mean injury to treatment delay (lag time) was 11 hours, and 10 patients received treatment after 12 hours. The overall amputation rate was 15%, but only 6.5% for those revascularised within 12 hours and 44% for those undergoing surgery after 12 hours (Chi-square 4.59, p < 0.05). Presence of associated fractures was associated with an adverse outcome (Chi-square 4.24, p < 0.05), as was ligation in comparison to revascularisation (Chi-square 7.86, p < 0.005). Popliteal injuries were associated with a high amputation rate. CONCLUSIONS Failure to revascularise (ligation of artery), presence of associated fracture, and restoration of circulation beyond 12 hours are associated with a high amputation rate.
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Affiliation(s)
- K M Rai
- Assoc Prof (Surgery), Armed Forces Medical College, Pune-411040
| | | | - R Kale
- Senior Adviser (Surgery & Paediatric Surgery), AH (RR), Delhi Cantt
| | | | - D Prasad
- Formerly Commandant, 92 BH, C/o 56 APO
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Ghallab NH. Overview of vascular injuries in Yemen: Experience from a single tertiary referral hospital. SURGICAL PRACTICE 2006. [DOI: 10.1111/j.1744-1633.2006.00281.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Degiannis E, Bonanno F, Titius W, Smith M, Doll D. [Treatment of penetrating injuries of neck, chest and extremities]. Chirurg 2006; 76:945-58. [PMID: 16175345 DOI: 10.1007/s00104-005-1095-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Penetrating injuries such as gunshot wounds have traditionally been rare in Europe, with the result that European surgeons have only limited experience in their management. Socio-economic changes in the last decade have led to an increase in the frequency of injuries of this type, partly due to the expansion of organized crime and partly because of involvement of the European military in peace-keeping missions in Europe and elsewhere in the world. The purpose of this article is to offer some guidelines in the management of extremely serious or rarely encountered injuries to the neck, chest and peripheral arteries and discuss controversies and possible future changes in their management as a result of the extensive experience of treating penetrating trauma in our hospital.
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Affiliation(s)
- E Degiannis
- Trauma Directorate, Chris Hani Baragwanath Hospital, University of the Witwatersrand -- Medical School, Johannesburg, South Africa
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