Asunto(s)
Arteriopatías Oclusivas/inducido químicamente , Arteriopatías Oclusivas/diagnóstico por imagen , Extremidad Inferior/irrigación sanguínea , Metisergida/efectos adversos , Trastornos Migrañosos/prevención & control , Tomografía Computarizada por Rayos X , Vasoconstrictores/efectos adversos , Arteriopatías Oclusivas/tratamiento farmacológico , Clopidogrel , Sustitución de Medicamentos , Femenino , Humanos , Persona de Mediana Edad , Oxazolidinonas/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Valor Predictivo de las Pruebas , Agonistas del Receptor de Serotonina 5-HT1/uso terapéutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento , Triptaminas/uso terapéuticoRESUMEN
OBJECTIVES: To describe the management of war-related vascular injuries in the Kabul French military hospital. METHODS: From January 2009 to April 2013, in the Kabul French military hospital, we prospectively included all patients presenting with war-related vascular injuries. We collected the following data: site, type, and mechanism of vascular injury, associated trauma, type of vascular repair, amputation rate and complications. RESULTS: Out of the 922 soldiers admitted for emergency surgical care, we recorded 45 (5%) patients presenting with vascular injuries: 30 (67%) gunshot-related, 11 (24%) explosive device-related, and 4 (9%) due to road traffic accident. The majority of injuries (93%) involved limbs. Vascular injuries were associated with fractures in 71% of cases. Twelve (26.7%) had an early amputation performed before evacuation. Twenty (44.4%) patients underwent fasciotomy and three (6.6%) sustained a compartment syndrome. CONCLUSIONS: This was the first French reported series of war-related vascular injuries during the last decade's major conflicts. The majority of injuries occurred in the limbs. Autologous vein graft remains the treatment of choice for arterial repair. Functional severity of these injuries justifies specific training for military surgeons.
Asunto(s)
Traumatismos por Explosión/cirugía , Vena Femoral/trasplante , Hospitales Militares , Medicina Militar/métodos , Personal Militar , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/cirugía , Adolescente , Adulto , Campaña Afgana 2001- , Amputación Quirúrgica/estadística & datos numéricos , Traumatismos por Explosión/mortalidad , Traumatismos por Explosión/fisiopatología , Fasciotomía , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/mortalidad , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/fisiopatología , Adulto JovenRESUMEN
Resection of neurogenic tumors located in the paravertebral sulcus carries a risk of injury to the adjacent nervous structures and also to critical intercostal arteries supplying the anterior spinal artery. To avoid such complications, we have used the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) for the dissection of neurogenic tumors in 2 consecutive patients operated on by videothoracoscopy. The Harmonic Scalpel functions with ultrasonic energy, producing less heat than a regular electrocautery and allows a safer dissection of tumors located in the posterior mediastinum, particularly those located in the superior paravertebral sulcus.