NEW YORK (Reuters Health) - In previous wars, battlefield surgeons often had to take the limb of a soldier with a bleeding leg or arm wound in order to save his life, but now with advances in vascular surgery, lives can often be saved without sacrificing a limb, a new study indicates.
“The purpose of our study was to show that with the proper resuscitation strategy, you have the option of saving the limb,” lead researcher Dr. Charles J. Fox, from the Walter Reed Army Medical Center in Washington, DC, told Reuters Health.
“We’re not speculating that that choice is ultimately going to be a good one for the patient, but we’re saying that you don’t necessarily have to make a decision to cut the leg off in order to save the patient,” added Fox, who spoke over the weekend at a gathering of vascular surgeons in New York City.
A number of advances have made it easier for battlefield surgeons to save limbs today than in the past, Fox said. More sophisticated tourniquets, an improved air evacuation system, having a vascular surgeon on the forward edge of the battlefield, and the incorporation of endovascular technologies are some of the changes he credited as increasing limb salvage rates.
A key factor in saving both life and limb is the concept of damage control resuscitation. With this approach, measures are taken to rapidly stop bleeding, reverse shock, and restore normal physiology.
According to Fox, damage control resuscitation starts with a colleague of the injured patient applying a tourniquet and appropriate dressing to the injured extremity and then calling for air medical evacuation. The patient is quickly transported to the ER of a level 3 hospital where they are met by a resuscitation team, treated and taken to the OR.
Fox described the short-term outcomes of 16 patients with life-threatening bleeding (loss of more than 4 units of packed red blood cells) who underwent 3 upper limb and 17 lower limb vascular reconstructions for a pulseless extremity between April and June 2006. All of the subjects survived surgery and had relatively normal physiology on admission to the intensive care unit, he reported.