2013 Templeton Pediatric Trauma Symposium

Of BIG HOLES in little vessels

Jeremy W. Cannon, MD, SM, FACSSan Antonio Military Medical Center

Trauma & Acute Care Surgeryjeremy.w.cannon@us.army.mil

Vascular Injury

Damage Control Resuscitation

Tourniquets

CT Angiogram

Damage Control Surgery

• Shunt• Fasciotomy• Technique

Blast event8 yo child—Cold R leg

Demographics

1-3 4

1Klinkner, et al. J Pediatr Surg 42:178, 20072Shah, et al. Jsurg Res 153:162, 20093Corneille, et al. JTrauma 70(4): 823, 20114Villamaria, et al. JTTR, 2011

Upper Ext29%

Lower Ext37%

Head/Neck/Face9%

Thoracic7%

Abd/Pelvis17%

Damage Control Resuscitation 1

Permissive hypotension

Replace shed blood

Limit crystalloid

Massive transfusion

Avoid hypothermia

DAMAGE CONTROL SURGERYDAMAGE CONTROL SURGERY

1Duchesne, et al. J Trauma 69(4):976, 2010

Damage Control

Tourniquets 1

Save LivesSave LivesNo Increase in AmputationsNo Increase in Amputations

1Kragh, et al. Ann Surg 249(1):1, 2009

Hemorrhage Control

Imaging3 yo child—R Hemothorax

CT Angiogram 1

Occult InjuriesOccult Injuries

1Cannon, Peck. Perspect Vasc Surg Endovasc Ther 23(2):100, 2010

Fragmentation

Torso

Cerebrovascular

Damage Control Surgery 1

Shunt-Stabilize-DC Dressing-ResuscitateShunt-Stabilize-DC Dressing-Resuscitate

1Rasmussen, et al. J Trauma 61(1):8, 2006

Zone of injury

Shunt techniqueStabilize bone

Debride wound

VAC dressing

Argyle

Angiocath

Operative Management

(Adjuncts)

Damage Control Surgery 1

Generous 4-compartment Generous 4-compartment FasciotomyFasciotomy

1Rasmussen, et al. J Trauma 61(1):8, 2006

Liberal FasciotomyMedial/Lateral Incisions

All 4 Compartments

VAC dressing

Operative Management

(Adjuncts)

Damage Control Surgery 1

Debride Injured VesselDebride Injured Vessel

1Rasmussen, et al. J Trauma 61(1):8, 2006

Reversed saphenous v.

Thrombectomy

Regional heparin

Papaverine

Interrupted prolene

Operative Management(Technique)

OutcomesOutcomes

Damage Control Resuscitation

Tourniquets

CT Angiogram

Damage Control Surgery

• Shunt• Fasciotomy• Technique

Summary8 yo child—Cold R leg

Training—ASSET-Peds?

Clinical Research—National Vascular Trauma Registry

Basic Research –Vascular Biology in the developing vessel

New Frontiers—Non-compressible torso hemorrhage

• Torso injuries: Blunt or penetrating solid organ

• Junctional Injuries

• Pelvis

The Future?

2013 Templeton Pediatric Trauma Symposium

Of BIG HOLES in little vessels

Jeremy W. Cannon, MD, SM, FACSSan Antonio Military Medical Center

Trauma & Acute Care Surgeryjeremy.w.cannon@us.army.mil

Vascular Injury