The Hip - book

6. Soft Tissue Coverage (Austere Environment) — Flaps and Vacuum-Assisted Closure (VAC)

COL Richard Pope MAJ Michelle Fontaine CPT Charles Grooters I. Soft Tissue Coverage in Austere Environment             A. Normally best performed in controlled environment with availability of microscope or loupe magnification             B. In rare circumstances, surgeons may need to perform soft tissue coverage procedures in austere environment when evacuation to higher echelon of care not feasible … Read more

8. Vascular Shunt

CPT David Crawford MAJ Joanna Branstetter Patient Preparation Always prep to allow access for proximal vascular control upper extremity: subclavian artery lower extremity: common femoral artery Preparation should include access to uninvolved limb in case vein graft is needed to be harvested Systemic heparinization (50-75 units/kg IV) should be initiated in stable patients with a … Read more

5. Escharotomy

CPT Daniel J. Stinner, M.D.   I. Introduction (see figure 3)             A. Typically performed at bedside under sterile condition with IV sedation using electrocautery             B. Can also be performed in operating room if immediate access available             C. Electrocautery has added benefit of haemostatic control, but if unavailable, scalpel can be used             D. General … Read more

3. External Fixation of Upper Extremity/Lower Extremity/Periarticular Fractures with Limited Resources (no X-ray)

CPT Jessica D. Cross CPT Daniel R. Possley I. Introduction             A. External fixation may be performed in austere environment without use of fluoroscopy             B. Ideally, pins should be placed to minimize impact on future internal fixation II. Pin Placement             A. Should be performed as follows (see femoral external fixation placement video) External Fixation – Joe … Read more

VII. Extremity Burns in an Austere Environment

CPT Daniel J. Stinner, M.D. CPT Chad A. Krueger, M.D.  A. Describe the initial evaluation and management of a burn patient   I. Background             A. Types of burn injuries                         1. thermal                         2. electrical                         3. chemical                         4. cold                         5. radiation             B. Recent civilian disasters resulting in multiple burn casualties1 … Read more

VII. Extremity Burns in an Austere Environment (continued)

CPT Daniel Stinner, M.D.    B. Define early management of extremity burns    I. Early Wound Management             A. Introduction                         1. not necessary to perform immediately, but should be done within first 24 hours                         2. ensure patient receives adequate pain medicine, as wound care can be very painful             B. Goal                                    1. … Read more

VIII. Extremity Vascular Injuries in an Austere Environment

CPT David Crawford MAJ Joanna Branstetter     A. Define the initial evaluation and demonstrate appropriate evaluation techniques of a patient with an extremity vascular injury   I. Initial Evaluation             A. Initial evaluation should always follow acute trauma lifesaving support (ATLS)             B. Application of a tourniquet above the level of injury is appropriate … Read more

VI. Compartment Syndrome in an Austere Environment

CPT Brendan Masini, MD     A. Define compartment syndrome and describe the diagnostic limitations presented by an austere environment   I. Acute Compartment Syndrome             A. Occurs when pressure within myofascial compartment exceeds threshold perfusion gradient across capillary beds                         1. if unchecked, leads to tissue hypoxia and cell death                         2. ischemia and necrosis … Read more

V. Axial Skeleton Injuries in an Austere Environment – I

CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D.     A. Describe the initial management, resuscitation, and stabilization of pelvic fractures   Pelvic Fractures I. Epidemiology             A. High energy mechanism of injury requires instantaneous deceleration of 30 mph to injure pelvic ring             B. Large association with other injuries including head, chest, abdomen, and extremity trauma … Read more

V. Axial Skeleton Injuries in an Austere Environment – II (continued)

V. Axial Skeleton Injuries in an Austere Environment (continued) CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D.     A. Describe the initial management, resuscitation, and stabilization of pelvic fractures   III. Resuscitation             A. Mortality rates as high as 40% with hemodynamic instability                         1. major cause of death in first 24 hours: exsanguinating … Read more