Electronic Thesis and Dissertation Repository

Degree

Master of Science

Program

Surgery

Supervisor

Dr Vivian McAlister

2nd Supervisor

Dr Adam Power

Joint Supervisor

Abstract

The way that soldiers are injured in modern conflicts has changed. Bullet and ballistic weapons are harming fewer casualties, and more commonly Improvised Explosive Devices (IED) are injuring them. The purpose of this thesis is to characterize the injury pattern of the antipersonnel IED (AP-IED) in victims from the Afghanistan conflict, to retrospectively examine the incidence and type of vascular trauma in a Canadian level 1 trauma center and to develop and novel device for control of junctional vascular injuries.

The injury pattern of 100 consecutive AP-IED victims was recorded. Multiple amputations occurred in 70% of IED victims: 5 quadruple amputations, 27 triple amputations, and 38 double amputations. Pelvic fractures occurred in 21 victims and severe perineal, gluteal or genital injuries were present in 46 patients. The casualty fatality rate was 19%.

All adult trauma patients who presented to a Canadian Level I trauma centre with injuries to named arterial or venous vessels from 1 January 2011- 31 December 2015 were reviewed. The majority of patients were male (70.1%) with an injury severity score of 15 or greater in 63.3%. Blunt mechanism accounted for 61.4%. Vessel injuries to the neck (20.4%), thorax (20.4%), abdomen/pelvis (19.7%), upper extremity (24.5%) and lower extremity (15.0%) were identified. Prehospital tourniquet use for arterial injuries occurred in 12.2%. Non-operative management was used in 39 patients (28.3%) and open and endovascular repair were undertaken on 59 (42.8%) and 17 (12.3%) respectively. No temporary intravascular shunts or balloon aortic occlusion devices were used. Thirteen different subspecialty disciplines managed vascular trauma at this centre.

A novel device for the control of pelvic and junctional hemorrhage was developed and tested. Placement of a catheter into the femoral vessel is followed by expression of the balloon with inflation by CO2 in a proximal direction. Thus it can navigate and treat damaged pelvic vasculature, occluding the distal aorta, and is technically simple to use. This CO2 balloon system was tested on model aortas with inline fluid flow and pressure monitoring to determine the maximum pressure the balloons could occlude. The device was tested on both intact and injured cadaveric porcine aortas for its ability to occlude fluid flow and to test the devices safety for use in arteries. The device was tested on a dye-perfused human cadaveric model. It can occlude fluid flow to supra-physiologic pressures and will rupture before injuring the vessel in the event of over inflation. It has the advantage of being able to navigate and treat injured pelvic vessels and is easy to use. This device may provide a tool to community hospitals and forward medical care providers in managing non-compressible pelvic hemorrhage.

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