Data from the Joint Theater Trauma Registry has led to changes in combat casualty care for Operations Iraqi and Enduring Freedom compared with previous wars. Currently, all recognized vascular injuries are repaired before leaving Iraq or Afghanistan. Extremity injuries are prevalent, accounting for the majority of reconstructive vascular surgery performed. Abdominal and chest injuries are less frequent in US forces than in local population, most likely because of the use of body armor. Increased use of tourniquets, modern advances in damage control resuscitation, and use of temporary vascular shunts are factors of increased survival. Use of autogenous or prosthetic grafts, vascular shunting, diagnostic imaging, and negative pressure wound therapy should continue to be encouraged. All of these advances contributed to an increase in amputation-free survival rates. The management of combat-related vascular injuries has progressed to the point of achieving reasonable outcomes for our country's military casualties.
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