Clinical utilization of deployed military surgeons.

BACKGROUND: Combat casualty care has been shaped by the prolonged conflicts in Southwest Asia, namely Afghanistan, Iraq, and Syria. The utilization of surgeons in austere locations outside of Southwest Asia and its implication on skill retention and value have not been examined. This study hypothesizes that surgeon utilization is low in the African theater. This lack of activity is potentially damaging to surgical skill retention and patient care. METHODS: Military case logs of surgeons deployed to Africa under command of Special Operations Command Africa between January 1, 2016, and January 1, 2020, were examined. Cases were organized based on population served, general type of procedure, current procedural terminology codes, and location. RESULTS: Twenty deployment caseloads representing 74% of the deployments during the period were analyzed. In 3,294 days, 101 operations were performed, which included 45 on combat/terrorism related injuries and 19 on US personnel. East and West African deployments, combat, and noncombat zones, respectively, were compared. East Africa averaged 4.1 ± 3.8 operations per deployment, and West Africa, 7.3 ± 8.0 (p = 0.2434). In East Africa, 56.1% of total operations were related to combat/terrorism, compared with 29.6% of total operations in West Africa (p = 0.0077). West Africa had a significantly higher proportion of elective (p = 0.0002) and humanitarian cases (p = <0.0001). CONCLUSION: Surgical cases for military surgeons were uncommon in Africa. The low volumes have implications for skill retention, morale, and sustainability of military surgical end strength. Reduction in deployment lengths, deployment location adjustments, and/or skill retention strategies are required to ensure clinical peak performance and operational readiness. Failure to implement changes to current practices to optimize surgeon experience will likely decrease surgical readiness and could contribute to decreased retention of deployable military surgeons to support global operations. LEVEL OF EVIDENCE: Economic/decision, level III.

Time to failure of arterial shunts in a pig hemorrhagic shock model.

Temporary vascular shunts (TVSs) are relied on frequently in the current military theater. Details of their physiology and outcome are of increasing interest and needed to further define their place in the management of trauma. This study was conducted using a porcine hemorrhagic shock model and aimed to 1) establish the time to failure of short, proximally placed vascular shunts; and 2) examine histological changes in the shunted artery. The external iliac artery of male pigs was transected and a straight shunt secured in place. Hemorrhagic shock was then induced by rapidly removing 40 per cent of blood volume and maintaining severe hypotension for 40 minutes before resuscitation. Animals were observed for up to 6 days for limb function as well as overall physiological status. At the conclusion of the experiment, status of the shunt and adjacent artery was evaluated by an independent pathologist. The presence of thrombi and inflammation within the proximal and distal artery was graded. Among the 10 animals tested, nine subjects survived the initial surgery. All shunts remained patent with mean time of 4.2±1.2 days of observation. Three-position histological analysis of the connected arterial tissues revealed minimal acute inflammation and minimal or thrombus. The results suggest that TVSs in proximal arteries remain functional for at least 48 to 72 hours in proximal arteries even without anticoagulation in the setting of brief hemorrhagic shock. This knowledge may aid combat evacuation patterns.