Gefässchirurgie

, Volume 16, Issue 2, pp 93–99 | Cite as

Kriegschirurgische Versorgung von Gefäßverletzungen der Extremitäten

Amerikanische Erfahrungen aus dem Irak und Afghanistan
Leitthema
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Zusammenfassung

Die sanitätsdienstliche Versorgung von verwundeten Soldaten ist eine Herausforderung an Mensch und Material. Waren es in der Vergangenheit Erfahrungen aus den Kriegen, die in die zivile Versorgung implementiert wurden, sind es nun zivile Erfahrungen, die in die unwirtliche Umgebung eines Kriegs einfließen.

Es sind insbesondere die durch wirkungsstärkere Munition und Splittereinwirkung bei gleichzeitig verbesserter persönlicher Schutzausstattung des Soldaten verursachten desaströsen Extremitätenverletzungen chirurgisch zu versorgen, die vormals aufgrund zentraler Verletzungen nicht überlebt wurden.

In 50–75% der Fälle sind die Extremitäten des Soldaten betroffen. 15% der Soldaten erleiden den Verblutungstod. In einem großen Prozentsatz kann eine Blutung mittels Tourniquet, direktem Druck oder durch Einsatz anderer externer Hämostyptika soweit versorgt werden, dass ein Transport zur ersten chirurgischen Versorgungseinrichtung erfolgen kann. In dieser sind in 4,4–7% der Fälle Gefäßverletzungen umgehend chirurgisch zu behandeln, um das Leben des Soldaten oder die betroffene Extremität zu retten.

War es im Ersten und Zweiten Weltkrieg die routinemäßige Ligatur des Gefässes, hat sich über die vergangenen Konflikte eine gefäßchirurgische Versorgung etabliert. Operation Iraqi Freedom (OIF) und Operation Enduring Freedom (OEF) bieten erstmals seit dem Vietnamkonflikt die Möglichkeit der Registererfassung von Gefäßverletzungen, das Evaluieren der chirurgischen Versorgungsstrategie bei Gefäßverletzungen unter widrigen Bedingungen und ggf. der Änderung derselben.

Ziel des folgenden Artikels ist es, dem Leser die Versorgung von Gefäßverletzungen an oberer und unterer Extremität anhand der amerikanischen Erfahrungen aus OEF/OIF nahe zu bringen.

Zusammenfassung

Kriegschirurgie Gefäßverletzung Damage control surgery OIF/OEF Verwundetenversorgung 

Surgical combat treatment of vascular injuries to the extremities

American experiences from Iraq and Afghanistan

Abstract

Delivery of combat health support means a challenge for personnel and material. Past military conflicts have provided lessons for civilian surgical practice, whereas nowadays civilian experiences influence military surgical practice in the austere environment of today’s battlefield.

Due to high explosives, ammunition and high-velocity missiles and also improved body armor, military surgeons have to deal with devasting extremity trauma, which has not been seen routinely in former conflicts because survival was not possible due to core injuries.

Extremity injuries represent 50–75% of all injuries sustained by soldiers and 15% of wounded soldiers die of exsanguination from extremity wounds. The bleeding from some of these injuries can be arrested by a tourniquet, direct pressure and/or hemostatic dressing application in the field allowing for casualty evacuation. Nevertheless, 4.4–7% of all injuries need definitive vascular surgical treatment because of ongoing life and limb-threatening hemorrhaging and ischemia.

From routine ligation of vascular injuries in World Wars I and II surgeons adapted to principles of in-theater repair of arterial and venous injuries in Korea and Vietnam.

Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) provided the first opportunities since Vietnam for the development of a registry of vascular injuries, the re-evaluation of established vascular surgical principles under austere conditions and adaptation where necessary.

The aim of the following article is to provide information on the current management of wartime vascular injuries on the basis of U.S. experiences in the on-going conflicts OIF/OEF.

Keywords

Vascular surgery War injuries Damage control surgery Combat injury OIF/OEF 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Abteilung für Allgemein-, Thorax- und ViszeralchirurgieSektion Gefäßchirurgie Bundeswehrkrankenhaus HamburgHamburgDeutschland
  2. 2.Klinik und Poliklinik für GefäßmedizinUniversitäres Herzzentrum, Universitätsklinikum Hamburg-EppendorfHamburgDeutschland

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