title: Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013).
abstract: This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war.
  
  
  
  From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included.
  
  
  
  Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%.
  
  
  
  The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War.
authors.affiliation: Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France. Electronic address: henridelesquen@gmail.com.
authors.forename: Henri
authors.initials: H
authors.lastname: de Lesquen
authors.affiliation: Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France. Electronic address: Fabien.beranger@laposte.net.
authors.forename: Fabien
authors.initials: F
authors.lastname: Beranger
authors.affiliation: Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France. Electronic address: Julie.berbis@ap-hm.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.affiliation: Department of Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France. Electronic address: g.boddaert@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Boddaert
authors.affiliation: French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France. Electronic address: aacp29@gmail.com.
authors.forename: Antoine
authors.initials: A
authors.lastname: Poichotte
authors.affiliation: French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France. Electronic address: frapons@me.com.
authors.forename: Francois
authors.initials: F
authors.lastname: Pons
authors.affiliation: Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France. Electronic address: avarojp@orange.fr.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Avaro
mesh_terms: D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D001753:Blast Injuries / Q000401:mortality / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D006488:Hemostasis, Surgical; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine / Q000379:methods; D008889:Military Personnel; D012189:Retrospective Studies; D066231:Surgeons / Q000592:standards*; D013536:Suture Techniques; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy / Q000401:mortality / Q000706:statistics & numerical data*; D014857:Warfare; D014948:Wounds, Gunshot / Q000401:mortality / Q000601:surgery*
keywords: Database; General surgery; Thoracic injury; Trauma