Interact CardioVasc Thorac Surg 2007;6:650-651. doi:10.1510/icvts.2007.158014A
© 2007 European Association of Cardio-Thoracic Surgery
ICVTS on-line discussion A Venous war injuries
Narcis Hudorovic
University Hospital Sestre Milosrdnice, Zagreb 10000, Croatia
Venous trauma in the Lebanon War – 2006
eComment: It is well known that injuries and deaths due to penetrating projectiles have become an international epidemic in today's society. The studies of penetrating trauma have been largely in the military domain where war-time specific applications were advanced with the use of highvelocity weapons. The principal goal of the studies of penetrating injuries in the civilian or/and soldier population is secondary prevention and optimized emergency care after occurrence. A thorough understanding of the dynamic biomechanics of penetrating injuries quantifies missile type, caliber, and velocity to hard and soft tissue damage [1,2]. Such information leads to a comprehensive assessment of the acute and long-term treatment of patients with penetrating injuries.
Wound ballistics is a largely different problem in today's surgical emergency centers and a thorough understanding of the dynamic biomechanics of penetrating injuries must include quantification and differentiation in the behaviors of the numerous available projectiles (for example: missile type, caliber, velocity, combinations in design, type of trauma center equipment, hard and soft tissue damage).
In the article by Nitecki et al. [3], the authors presented well the results after surgical treatment of venous wounds caused by high-velocity [2000 feet per second] long-range missiles (optimal duration of postoperative antibiotic treatment, intraoperatively/postoperatively administration of Heparin, measures for prevention of tromboembolic complications) which could be comparable to previously published and further relevant military and civil research. Moreover, quantified data could assist young surgeons in the management of complications of penetrating venous wounds in highly contaminated areas.
Nitecki et al. overwhelmed the previously published results which referred to surgical repair of venous injury from World War II, Korean War, Vietnam War and War in Croatia. Combined with presented clinical results we must always bear in mind the formula for kinetic energy (it is one-half mass times the square of velocity–KE=1/2 mv2) while, there are a wide variety of weapons for inflicting injury upon victims. There is a predictable behavior of traveling projectiles from within the firearm to the time they strike the target; however, once they strike the target, there are several factors which make this a very complex process depending on the mass, velocity, and the type of ammunition used. The degree of injury is estimated by the amount of kinetic energy which is released by the projectile to the surrounding tissue. Representing data by Nitecki et al. combined with biomechanical rules may assist clinical personnel in the management of penetrating venous injuries.
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- Biocina B, Sutlic Z, Husedzinovic I, Rudez I, Ugljen R, Letica D, Slobodnjak Z, Karadza J, Brida V, Vladovic-Relja T, Jelic I. Penetrating cardiothoracic war wounds. Eur J Cardiothorac Surg 1997; 11:399–405.[Abstract]
- Lovric Z, Wertheimer B, Candrlic K, Kuvezdic H, Lovric I, Medaric D, Janosi K. War injuries of major extremity vessels. J Trauma 1994; 36:248–251.[Medline]
- Nitecki S, Karram T, Hoffman A, Bass A. Venous trauma in the Lebanon war – 2006. Interact CardioVasc Thorac Surg 2007; 6:647–651.[Abstract/Free Full Text]
Related Article
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Venous trauma in the Lebanon War – 2006
- Samy S. Nitecki, Tony Karram, Aaron Hoffman, and Arie Bass
Interactive CardioVascular and Thoracic Surgery 2007 6: 647-650.
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