Exploratory Laparotomy for Proximal Vascular Control in Combat-Related Injuries

Area of Science:

• Trauma Surgery
• Military Medicine
• Surgical Critical Care

Background:

• Combat casualties face increased lower extremity amputations due to improvised explosive devices.
• Surgical control of proximal vasculature is often necessary in these cases.
• This study evaluates exploratory laparotomy (EXLAP) for proximal control (PC) in combat-injured patients.

Purpose of the Study:

• To assess the safety and outcomes of exploratory laparotomy (EXLAP) for achieving proximal vascular control (PC) in combat casualties.
• To compare complication rates between patients requiring PC and those not requiring PC via EXLAP.
• To identify potential areas for improvement in surgical management of vascular injuries in combat settings.

Main Methods:

• Retrospective review of 845 combat casualties from June 2009 to December 2011.
• Patients undergoing EXLAP were categorized into proximal control (PC) and non-PC groups.
• Data collected included demographics, Injury Severity Score, injury mechanism, transfusion needs, EXLAP findings, reoperation rates, and abdominal complications.

Main Results:

• 44 patients required PC, while 91 did not. The PC group had a higher Injury Severity Score (25.8 vs. 21.4) and significantly more lower extremity amputations (93.1% vs. 28.6%).
• While days to fascial closure and number of EXLAPs were similar, the PC group experienced higher overall complication rates (43.1% vs. 24.2%).
• Proximal control via EXLAP was associated with increased abdominal complications.

Conclusions:

• Proximal control (PC) through exploratory laparotomy (EXLAP) in combat casualties is linked to a higher incidence of abdominal complications.
• The underlying reasons for these increased complications require further investigation.
• Exploring alternative methods for proximal vascular control and enhancing predeployment training for general surgeons are recommended to mitigate surgical morbidity.