title: Extremity vascular injuries on the battlefield: tips for surgeons deploying to war.
abstract: BACKGROUND
  Recent events have refocused attention on certain principles regarding the surgical management of casualties on the battlefield. Extremity vascular injuries predominate, representing 50 to 70% of all injuries treated during Operation Iraqi Freedom, and exsanguination from extremity wounds is the leading cause of preventable death on the modern battlefield. Recent advances in military medicine have translated into a greater percentage of wounded soldiers surviving during Operations Enduring and Iraqi Freedom than in any other previous American conflict. The combat-experienced military surgeon, a fraction of those in uniform until recently, rarely has had the opportunity to convey lessons learned to the newly indoctrinated war surgeon. The purpose of this review is to do exactly that.
  
  
  METHODS
  We collectively reviewed the experience and opinions of five U.S. Army surgeons with regard to management of extremity vascular injuries in a combat zone
  
  
  RESULTS
  The modern battlefield has a staunch reputation of being unclean, noisy, and lacking of valuable resources. High-kinetic energy injuries such as those resulting from high explosives, munitions, and high-velocity missiles often cause soft-tissue destruction that is not routinely seen in civilian settings. Military-specific considerations in the management of these injuries are reviewed.
  
  
  CONCLUSIONS
  The management of extremity vascular injuries on the modern battlefield presents many unique and demanding challenges to even the most seasoned of surgeons. Preparation goes a long way in overcoming some of the obstacles to seamless patient care.
authors.affiliation: Department of Surgery: General Surgery Services, Madigan Army Medical Center, Tacoma, Washington 98431-1100, USA. bwstarnes@comcast.net
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Starnes
authors.forename: Alec C
authors.initials: AC
authors.lastname: Beekley
authors.forename: James A
authors.initials: JA
authors.lastname: Sebesta
authors.forename: Charles A
authors.initials: CA
authors.lastname: Andersen
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rush
mesh_terms: D000671:Amputation, Surgical; D001808:Blood Vessels / Q000293:injuries*; D003646:Debridement; D003657:Decision Making; D005121:Extremities / Q000098:blood supply / Q000293:injuries; D006297:Health Services Accessibility; D006772:Hospitals, Military; D006775:Hospitals, Packaged; D006801:Humans; D007493:Iraq; D023821:Limb Salvage; D008887:Military Medicine / Q000193:education / Q000295:instrumentation / Q000379:methods*; D018579:Patient Selection; D010360:Patient Transfer; D019990:Perioperative Care / Q000379:methods; D019095:Point-of-Care Systems; D014111:Tourniquets; D014187:Transportation of Patients; D014218:Triage; D014481:United States; D014656:Vascular Surgical Procedures / Q000193:education / Q000295:instrumentation / Q000379:methods*; D014857:Warfare; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*