The Necessity of Surgical Resident Training in Damage Control Vascular Surgery: A Third World Experience

Objectives: Vascular injuries pose a major challenge for all surgeons even those who are experienced, especially in low/limited resources austere environments. To evaluate the 10 years' experience with damage control vascular surgery (DCVS) in managing vascular injuries in different rural emergency centers, with special emphasis on the rule of surgical residence. Methods: This was a 3-year retrospective study from December 2016 to January 2019, to report all cases of isolated vascular trauma that were referred to our center with an emergency vascular trauma from different rural emergency centers. Patients' files were thoroughly reviewed to report the type of vascular injury, the initial DCVS, and the rank of the surgeon who performed the initial management before referral. Results: A total of 240 patients were reported. They were 160 males and 80 females with a male-to-female ratio of 3:1. Their age ranged from 15 to 67 years with the median age 38.5 ± 1.5 years. In 195 patients, the cause of vascular injury was road traffic accident in whom 71 suffered from major trauma to the femoral artery, while the remaining 24 patients experienced trauma to the femoral vein. The remaining 175 patients were victims of assaults by gunshot in 45 patients or direct penetrating stab or contused wound in 130 patients. The mean time between the initial injury and the primary DCVS that was done at the original center ranged from 7 to 20 h, with the mean of 12.5 ± 2.6. Limb salvage was successful in 112 patients. Out of them, 107 initially underwent the DCVS by experienced surgeons, while the remaining five patients were treated by residents with different scopes of experience. Limbs were sacrificed in 128 patients because of failure of the DCVS. In those patients, amputation was performed as a life-saving procedure. Conclusion: Damage control vascular surgery is an effective tool in limb salvage in trauma patient. It should be a major part of Junior and senior residents in the developing countries to save the hospital resources and to decrease the cost-effectiveness of health care.

Publication History

Article published online:
26 April 2021