The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up.
BACKGROUND
The use of temporary vascular shunts (TVS)s in the management of wartime extremity vascular injuries has received an increasing amount of attention. However, the overall impact of this adjunct remains incompletely defined. The objective of this study is to characterize outcomes of those patients who suffered wartime extremity vascular injuries managed with TVSs.


METHODS
This is a retrospective review of the Navy and Marine Corps Combat Trauma Registry examining peripheral vascular injuries treated during the military conflicts in the Middle East. Patient demographics, injury severity score, mechanism of injury, and vessels injured were recorded. Operative reports were reviewed for use of TVSs, type of definitive repair, the need for amputation, and survival.


RESULTS
Eighty patients were included. Forty-six (57%) had TVSs placed and 34 (43%) underwent repair at initial presentation. The mean injury severity score for the TVS group and the non-TVS groups were 15.0 +/- 5.05 and 12.9 +/- 10.18, respectively, (p = 0.229). There were a total of 13 amputations, 6 (13%) in the TVS group and 7 (21%) in the non-TVS group (p = 0.38). There was no difference in amputation rates between either group. There were no recorded mortalities in either group. Median patient follow-up was 24.5 months (range, 3-48 months).


CONCLUSIONS
This study demonstrates the importance and utility of TVSs in the management of wartime extremity vascular injury. When used to restore perfusion to an injured extremity, there seems to be no adverse effects or overall increase in limb loss rates and therefore a useful adjunct in the surgery for limb salvage.
Borut
L T Jeffrey
LT
United States Navy, United States Navy Research Center, Naval Medical Center, San Diego, California, USA. jeffborut@hotmail.com
Acosta
Capt José A
CJ
Tadlock
L C D R Matthew
LC
Dye
Judy L
JL
Galarneau
Michael
M
Elshire
Capt Donnel
CD
D001134:Arm Injuries / Q000601:surgery*; D001158:Arteries / Q000293:injuries; D019917:Blood Vessel Prosthesis Implantation; D001808:Blood Vessels / Q000293:injuries*; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008887:Military Medicine / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000293:injuries; D055815:Young Adult