title: Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during Operation Iraqi Freedom: one unit's experience.
abstract: BACKGROUND
  Rapidly restoring perfusion to injured extremities is one of the primary missions of forward military surgical teams. The austere setting, limited resources, and grossly contaminated nature of wounds encountered complicates early definitive repair of complex combat vascular injuries. Temporary vascular shunting of these injuries in the forward area facilitates rapid restoration of perfusion while allowing for deferment of definitive repair until after transport to units with greater resources and expertise.
  
  
  METHODS
  Standard Javid or Sundt shunts were placed to temporarily bypass complex peripheral vascular injuries encountered by a forward US Navy surgical unit during a six month interval of Operation Iraqi Freedom. Data from the time of injury through transfer out of Iraq were prospectively recorded. Each patient's subsequent course at Continental US medical centers was retrospectively reviewed once the operating surgeons had returned from deployment.
  
  
  RESULTS
  Twenty-seven vascular shunts were used to bypass complex vascular injuries in twenty combat casualties with a mean injury severity score of 18 (range 9-34) and mean mangled extremity severity score of 9 (range 6-11). All patients survived although three (15%) ultimately required amputation for nonvascular complications. Six (22%) shunts clotted during transport but an effective perfusion window was provided even in these cases.
  
  
  CONCLUSIONS
  Temporary vascular shunting appears to provide simple and effective means of restoring limb perfusion to combat casualties at the forward level.
authors.affiliation: Department of Surgery, First Medical Battalion/Naval Hospital Camp Pendleton, Camp Pendelton, California 92055-5191, USA.
authors.forename: Lowell W
authors.initials: LW
authors.lastname: Chambers
authors.forename: D J
authors.initials: DJ
authors.lastname: Green
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sample
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Gillingham
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: Nalan
authors.initials: N
authors.lastname: Narine
authors.forename: John M
authors.initials: JM
authors.lastname: Uecker
authors.forename: Harold R
authors.initials: HR
authors.lastname: Bohman
mesh_terms: D000293:Adolescent; D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D001808:Blood Vessels / Q000293:injuries*; D002648:Child; D006801:Humans; D015601:Injury Severity Score; D007493:Iraq; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D011183:Postoperative Complications; D014857:Warfare; D014947:Wounds and Injuries / Q000601:surgery*