title: Concomitant Vascular War Trauma Saturating a French Forward Surgical Team Deployed to Support the Victims of the Syrian War (2013). Interest of the Vascular Damage Control.
abstract: Vascular injuries from war require an emergency treatment whose objective is to quickly obtain hemostasis and the restoration of arterial flow. In this context of heavy trauma and limited means, damage control surgery is recommended and is based on the use of temporary vascular shunts (TVSs). We report the management of the simultaneous arrival of 2 vascular injuries of war in a field hospital. Patient 1 presented a ballistic trauma of the elbow with a section of the humeral artery (Gustillo IIIC). A TVS was set up during the external fixation of the elbow. Final revascularization was carried out and aponevrotomies of the forearm were performed. Patient 2 had a riddled knee with an open fracture of the femur, an avulsion of the popliteal artery, and a hemorrhagic shock. A strategy of damage control surgery was carried out with placing an arterial and venous shunt. Aponevrotomies of the leg were carried out before casting. For the traumatisms of the arteries of the members, the use of shunts is reserved for the lesions of the proximal vessels. Many vascular shunts available have the same performances to restore the arterial flow and prevent secondary thrombosis. The time before the final revascularization depends on the clinical condition of the patient. The value of anticoagulation in these cases was not shown.
authors.affiliation: Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France. Electronic address: Emmanuelhornez@gmail.com.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hornez
authors.affiliation: Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Boddaert
authors.affiliation: Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Baudoin
authors.affiliation: Département d'anesthésie et réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Daban
authors.affiliation: Service de chirurgie orthopédique, Hôpital d'Instruction des Armées Begin, Toulon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Ollat
authors.affiliation: Département d'anesthésie et réanimation, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Ramiara
authors.affiliation: Service de chirurgie viscérale et thoracique, Hôpital d'Instruction des Armées Percy, Clamart, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D005602:France; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D013593:Syria; D057772:Vascular System Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D014857:Warfare; D014948:Wounds, Gunshot / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult