The Use of Temporary Vascular Shunts in Military Extremity Wounds: A Preliminary Outcome Analysis With 2-Year Follow-Up
The Use of Temporary Vascular Shunts in Military Extremity Wounds: A Preliminary Outcome Analysis With 2-Year Follow-Up
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DOI：
10.1097/ta.0b013e3181e03e71
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发表时间：
2010-07-01
影响因子：
--
通讯作者：
Elshire, Donnel
中科院分区：
文献类型：
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作者：
Borut, L. T. Jeffrey;Acosta, Jose A.;Elshire, Donnel
背景：临时血管分流术（TVS）在战时四肢血管损伤治疗中的应用受到越来越多的关注。然而，这种辅助手段的总体影响仍未完全确定。本研究的目的是描述那些经 TVS 治疗的战时四肢血管损伤患者的结果。方法：这是对海军和海军陆战队战斗创伤登记处的回顾性审查，检查了中东军事冲突期间治疗的外周血管损伤。记录患者人口统计数据、损伤严重程度评分、损伤机制和受伤血管。审查了手术报告中 TVS 的使用、最终修复的类型、截肢的需要以及生存率。结果：纳入了 80 名患者。 46 例 (57%) 患者放置了 TVS，34 例 (43%) 在初次就诊时接受了修复。 TVS 组和非 TVS 组的平均损伤严重程度评分分别为 15.0 +/- 5.05 和 12.9 +/- 10.18 (p = 0.229)。共有 13 例截肢，其中 TVS 组 6 例（13%），非 TVS 组 7 例（21%）（p = 0.38）。两组之间的截肢率没有差异。两组均没有死亡记录。中位患者随访时间为 24.5 个月（范围为 3-48 个月）。结论：本研究证明了 TVS 在战时四肢血管损伤治疗中的重要性和实用性。当用于恢复受伤肢体的灌注时，似乎没有副作用或肢体丧失率总体增加，因此是保肢手术中的有用辅助手段。
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.