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Operational Medicine 2001
Emergency War Surgery
Second United States Revision of The Emergency War Surgery NATO Handbook
United States Department of Defense

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Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries

Adjunctive Therapy

United States Department of Defense


Intravenous broad spectrum antibiotic therapy should be initiated as soon as possible after injury. This should be continued throughout the operation and for roughly 24 hours thereafter, assuming there is no continued source of contamination. In most instances, a cephalosporin provides effective prophylaxis.

Anticoagulation of the distal arterial tree is acceptable during operation, but one must be aware that, because of collateral flow, locally injected heparin ultimately becomes systemic. For this reason, relatively small doses of heparin (1500-3000 units at a concentration of 100 units per cc of physiologic saline) are used for anticoagulation of a lower extremity. Systemic anticoagulation is usually not advisable because of the presence of associated injuries. There is rarely, if ever, an indication for postoperative anticoagulation. Adjunctive agents, such as low molecular weight dextran, may be used and may be of value particularly after small artery repairs; however, dextran must be used with caution to prevent volume overload. In most instances, vascular repairs will be successful if the tissues are adequate, the repair is done well, and the hemodynamic and volume status of the patient are kept within normal limits postoperatively.

Although preoperative arteriograms are rarely available in the combat setting, single-shot handinjected intraoperative arteriograms can be easily obtained and are helpful to rule out additional arterial injuries, distal thrombosis, and inadequacy of the repair. Injection of full-strength contrast (Radio-Conray 60) through a 19 gauge needle usually results in an excellent study. Fifteen to 20 cc is usually all that is needed. The film should be exposed while the contrast material is still being injected. At times, run-off may be so rapid that the contrast is washed out by the time the film is exposed. Should this occur, a second injection with inflow occlusion will usually provide adequate visualization. Sympathetic blocks and sympathectomy are of no value in the management of acute arterial injuries. Sympathectomy, as a delayed procedure, may occasionally be helpful to the patient who has had a suboptimal result from arterial repair.

 

 


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Operational Medicine 2001

Health Care in Military Settings

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001

United States Special Operations Command
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MacDill AFB, Florida
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This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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