2013 Templeton Pediatric Trauma Symposium
Of BIG HOLES in little vessels
Jeremy W. Cannon, MD, SM, FACSSan Antonio Military Medical Center
Trauma & Acute Care [email protected]
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 [email protected]
Vascular Injury
