Kriegschirurgische versorgung von gefäverletzungen der extremitäten: Amerikanische erfahrungen aus dem Irak und Afghanistan

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.