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Wie viel gefäßchirurgische Notkompetenz benötigt der moderne Unfallchirurg

Erfahrungen vor dem Hintergrund des Einsatzes als Bundeswehrchirurg

How much competence in emergency vascular surgery does a modern trauma surgeon need?

Experiences regarding deployment as a military surgeon

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Zusammenfassung

Die Versorgung schwerer Gefäßverletzungen unter Kriegsbedingungen bedeutet für jeden Chirurgen eine Herausforderung. Da ein Gefäßspezialist im Einsatz nicht immer verfügbar ist, muss der Einsatzchirurg – gleich mit welcher chirurgischen Subspezialisierung im Heimatland – vor Ort in der Lage sein, diese Leib und Leben des Soldaten bedrohenden Verletzungen zu diagnostizieren und zu versorgen. Mittels Medline- und Google-Suche wurde eine Datenanalyse der gefäßchirurgischen Verletzungsmuster und Behandlungsleitlinien im Afghanistan- und Irakeinsatz der Streitkräfte der USA durchgeführt. Dies wurde in Beziehung zur aktuellen Situation des Sanitätsdienstes der Bundeswehr und den bestehenden Konzepten gestellt. Bei 5–7% aller Verwundeten muss mit einer schweren Gefäßverletzung gerechnet werden. Während zunächst mit geeigneten Notfallmaßnahmen die Blutung kontrolliert und die Perfusion sichergestellt wird, erfolgt in rückwärtigen Einrichtungen die definitive Gefäßrekonstruktion. Der im Einsatzland tätige Chirurg muss daher mit der Versorgung von Gefäßverletzungen ausreichend vertraut sein und sollte folgende Notkompetenz besitzen: Grundkenntnisse in der Diagnostik, Fertigkeiten bei der temporären Überbrückung eines verletzten Gefäßes mit einem intraluminalen Shunt, bei der Handhabung eines Fogarty-Katheters zur Thrombektomie sowie der arteriellen Rekonstruktion mittels Interponat oder Bypass.

Abstract

Management of combat-related major vascular injuries is a challenge to all surgeons and a vascular specialist will not always be available in a wartime setting; therefore, every surgeon deployed to a war setting must be able to cope with these life and limb-threatening injuries. Data obtained from searching Medline and Google on the localization and treatment of combat-related vascular injuries of the USA strike forces in Afghanistan and Iraq were analyzed and adjusted to the requirements of the German Armed Forces. A total of 5–7% of casualties sustained major vascular injuries. After initial treatment using damage control measures to control the bleeding and restore perfusion definitive repair with vascular reconstruction must be performed in a facility with a higher level of care. Basic vascular surgical techniques which all military surgeons need to know are presented taking the austere conditions of a wartime environment into consideration. Preparation of all surgeons for deployment to a wartime situation must include basic knowledge and skills in vascular surgery including emergency and vascular reconstruction techniques.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Chirurgisches Zentrum, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    K. Elias & M. Engelhardt

  2. Chirurgisches Zentrum, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    C. Willy

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  1. K. Elias
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  2. C. Willy
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  3. M. Engelhardt
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Correspondence to K. Elias.

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Elias, K., Willy, C. & Engelhardt, M. Wie viel gefäßchirurgische Notkompetenz benötigt der moderne Unfallchirurg. Unfallchirurg 113, 122–126 (2010). https://doi.org/10.1007/s00113-010-1740-9

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