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Management of Combat Injuries

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Early decompressive craniectomy for severe penetrating and closed head injury during wartime.
Bell RS, Mossop CM, Dirks MS, Stephens FL, Mulligan L, Ecker R, Neal CJ, Kumar A, Tigno T, Armonda RA.
Neurosurg Focus. 2010 May;28(5):E1.

Rationale for inclusion: This study is a large review of combat patients with head injuries who underwent decompressive craniectomy for severe TBI in theater. Craniectomy was employed for those with worse initial presentations and was noted to be associated with improved outcomes over time. 

Citations - 80 (as of July 2017)

Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system.
Bell RS, Vo AH, Neal CJ, Tigno J, Roberts R, Mossop C, Dunne JR, Armonda RA.
J Trauma. 2009 Apr;66(4 Suppl):S104-11.

Rationale for inclusion: This is a large retrospective review of combat injured patients evacuated to a military Role V hospital for neurosurgical evaluation. This study details the epidemiology of combat related neurologic injury in the recent wars in Iraq and Afghanistan.

Citations - 148 (as of July 2017)

Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq.
Stansbury LG, Lalliss SJ, Branstetter JG, Bagg MR, Holcomb JB.
J Orthop Trauma. 2008 Jan;22(1):43-6.

Rationale for inclusion: This study from early in the Afghanistan and Iraq wars reviewed over 5000 patients with limb injuries. This is a detailed epidemiological review on the injury patters, level of amputations, and mechanism of injury.

Citations - 132 (as of July 2017)

Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom.
Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC.
J Orthop Trauma. 2007 Apr;21(4):254-7.

Rationale for inclusion: Extremity wounds have been commonly reported in the most recent wars. This is an epidemiological study of a large cohort of combat injured patients with extremity injuries describing anatomic location, mechanisms of injury, and characteristics of the injuries.

Citations - 387 (as of July 2017)

The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury.
Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL.
J Trauma. 2006 Jul;61(1):8-12; discussion 12-5.

Rationale for inclusion: This study details over 120 combat injured patients with vascular injuries treated at far forward locations. Temporary vascular shunts were used in the management of more than 50% with resultant good outcomes.

Citations - 217 (as of July 2017)

Contemporary management of wartime vascular trauma.
Fox CJ, Gillespie DL, O'Donnell SD, Rasmussen TE, Goff JM, Johnson CA, Galgon RE, Sarac TP, Rich NM.
J Vasc Surg. 2005 Apr;41(4):638-44.

Rationale for inclusion: This paper is from early on in the Iraq and Afghanistan wars and includes over 100 combat patients with vascular injuries. Details regarding amputation rates, vascular repair in far forward surgical settings and additional operative interventions required up-range are discussed.

Citations - 224 (as of July 2017)

Acute arterial injuries in Vietnam: 1,000 cases.
Rich NM, Baugh JH, Hughes CW.
J Trauma. 1970 May;10(5):359-69.

Rationale for inclusion: This is a large review with data on mechanism of injury, location of injury, management choices, morbidity and mortality by another giant in military surgery, Dr. Norm Rich.

Citations - 547 (as of July 2017)

Battle injuries of the arteries in World War II: an analysis of 2,471 cases.
Debakey ME, Simeone FA.
Ann Surg. 1946 Apr;123(4):534-79.

Rationale for inclusion:  As much a historical lesson than a scientific paper, Dr. DeBakey reviews over 2000 cases of vascular injuries compared from civil war through WWII. There are detailed descriptions of anatomic injuries, amputation rates, options for repair, etc.

Citations - 1094 (as of July 2017)

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