RESUMO
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.
Assuntos
Traumatismos por Explosões/cirurgia , Veia Femoral/transplante , Hospitais Militares , Medicina Militar/métodos , Militares , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Campanha Afegã de 2001- , Amputação Cirúrgica/estatística & dados numéricos , Traumatismos por Explosões/mortalidade , Traumatismos por Explosões/fisiopatologia , Fasciotomia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/mortalidade , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/fisiopatologia , Adulto JovemAssuntos
Arteriopatias Oclusivas/induzido quimicamente , Arteriopatias Oclusivas/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Metisergida/efeitos adversos , Transtornos de Enxaqueca/prevenção & controle , Tomografia Computadorizada por Raios X , Vasoconstritores/efeitos adversos , Arteriopatias Oclusivas/tratamento farmacológico , Clopidogrel , Substituição de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Oxazolidinonas/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Valor Preditivo dos Testes , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Triptaminas/uso terapêuticoRESUMO
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.
