Concept and evaluation of the German War Surgery Course - Einsatzchirurgie-Kurs der Bundeswehr.

INTRODUCTION: Military surgeons must be prepared to care for severe and complex life-threatening injuries rarely seen in the civilian setting. Typical civilian training and practice do not provide adequate exposure to the broad set of surgical skills required. The German Bundeswehr Medical Service has developed and refined the War Surgery Course (WSC) to meet this training gap. This article describes the recent experience with this readiness curriculum. METHODS: Run annually since 1998, WSC consists nowadays of 5 days with 20 theoretical modules. Four sessions with standardised practical skills training use a live tissue porcine model, and the recently added cadaver-based Advanced Surgical Skills for Exposure in Trauma course. Sixteen military surgeons who participated in the WSC in January 2016 completed a survey of their self-rated readiness for 114 predefined emergency skills before and after completion, and provided an overall evaluation of the course. RESULTS: Self-assessed readiness improved significantly over baseline for all areas covered in both the practical skills and theoretical knowledge portions of the WSC curriculum. Additionally, all participants rated the course as important and universally recommended it to other military surgeons preparing for missions. CONCLUSIONS: The WSC course format was well received and perceived by learners as a valuable readiness platform. Ongoing evaluation of this course will enable data-driven evolution to ensure a maximum learning benefit for participants. With the increasing multinational nature of modern military missions, surgeons' training should follow international standards. Continuing evolution of military surgical training courses should further encourage the sharing and adoption of best educational practices.

[Bullet and shrapnel injuries in the face and neck regions. Current aspects of wound ballistics]. / Schuss- und Splitterverletzungen im Gesichts- und Halsbereich. Aktuelle Aspekte zur Wundballistik.

A basic understanding of the ballistic behaviour of projectiles or fragments after entering the human body is essential for the head and neck surgeon in the military environment in order to anticipate the diagnostic and therapeutic consequences of this type of injury. Although a large number of factors influence the missile in flight and after penetration of the body, the most important factor is the amount of energy transmitted to the tissue. Long guns (rifles or shotguns) have a much higher muzzle energy compared to handguns, explaining why the remote effects beyond the bullet track play a major role. While most full metal jacket bullets release their energy after 12-20 cm (depending on the calibre), soft point bullets release their energy immediately after entry into the human body. This results in a major difference in extremity wounds, but not so much in injuries with long bullet paths (e.g. diagonal shots). Shrapnel wounds are usually produced with similarly high kinetic energy to those caused by hand- and long guns. However, fragments tend to dissipate the entire amount of energy within the body, which increases the degree of tissue disruption. Of all relevant injuries in the head and neck region, soft tissue injuries make up the largest proportion (60%), while injuries to the face are seen three times more often than injuries to the neck. Concomitant intracranial or spinal injury is seen in 30% of cases. Due to high levels of wound contamination, the infection rate is approximately 15%, often associated with a complicated and/or multiresistant spectrum of germs.

[Open intraperitoneal hernia repair for treatment of abdominal wall defects--early results by placement of a polypropylene-ePTFE-mesh]. / Die offene intraperitoneale Netzplastik zur Versorgung ventraler Bauchdeckendefekte--erste Ergebnisse bei der Implantation eines mit ePTFE beschichteten Polypropylenenetzes.

BACKGROUND: Large incisional hernias are mainly repaired today by tension free implantations of prosthetic meshes using various placement methods. The advantages of the intraperitoneal open technique (IPOM) using a polypropylene mesh that is coated with ePTFE on the side facing the intestine, are described. METHODS AND RESULTS: 62 patients underwent an incisional hernia operation with the intraperitoneal positioning of a prosthetic mesh. The follow-up examinations after a range of 16.1 months showed a hernial recurrence rate of 6.4 %. A part of the resulting mesh infections (11.2 %) healed without surgical removal of the mesh. Clinical complications due to adhesion formation were not observed. CONCLUSION: The tissue sparing intraabdominal positioning technique simplifies the necessary overlap using healthy tissue as a prerequisite for a sufficient hernia repair exploiting the intraabdominal pressure.

[Must the recurrent nerve in thyroid gland resection always be exposed? A prospective randomized study]. / Muss der Nervus recurrens bei der Schilddrüsenresektion immer freipräpariert werden? Eine prospektiv randomisierte Studie.

It was the purpose of this study to establish whether it is necessary to identify the recurrent laryngeal nerve intraoperatively when resecting the endemic nodular goiter. We prospectively formed two groups from 800 subtotal unilateral resections ("nerves at risk"). In group I (382 subtotal resections, 48.4%) the nerve was not identified intraoperatively. In group II (413 subtotal resections, 51.6%) the recurrent laryngeal nerve was routinely identified in all cases. The operative technique was standardized, giving special attention to the "anterior lamella". For all patients, preoperative and postoperative evaluation of the vocal cords was performed routinely. Altogether we saw 4 (0.5%) transient vocal cord palsies: 2 in group I and 2 in group II. All 4 laryngeal nerve palsies recovered within 4 months. These data demonstrated that no benefit is gained from routine dissection of the laryngeal nerve during resection of endemic nodular goiter. Therefore the demand for obligatory intraoperative identification of the recurrent nerve is not tenable.