Who should perform vascular surgery for trauma?

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Mike--
Whoever can do vascualr trauma shouold do it.  It must be someone who is familiar with the basic principles of vascular diagnosis and surgical approaches, as well as someone who is familiar with the application of these precepts in the setting of trauma, which is quite different than elective vascular surgery.  My experience is like yours, that those vascular surgeons who do not do trauma are usually at sea on a major vascualr injury peripherally, and this is no different from general surgeons, urologists, cardiac surgeons, etc who do not do trauma.  General surgeons have the working familiarity with vascualr surgey from their residency, but generally do not do this surgery in practice.  I think all trauma services should train their fellows in vascualr trauma--there is no one good answer here, as it is difficult for any surgeon to do a case that he/she has not done in awhile, but I agree that they are well equipped to try in the field as they have the basic traiing to make a good shot if there is no one else
ERF 
 
 
-----Original Message-----
From: Sise.Mike at scrippshealth.org
To: trauma-list at trauma.org
Sent: Fri, 4 Aug 2006 10:52 AM
Subject: Who should perform vascular surgery for trauma?


To my colleagues,
 
I help teach TRACS, a refresher advanced trauma surgery course for Navy Surgeons 
headed to Iraq and Afghanistan. Many of the attendees have already done  a tour 
there and I always learn from their experience. This week we had an interesting 
discussion on vascular repairs. All have and will have to treat complex vascular 
injuries. They have taught us much about damage control and evacuation with the 
use of shunts. However, there is a basic question always faced by the combat 
surgeon who hasn't done an unsupervised vascular repair since his or her 
residency - What should I take on? 
 
I've recommended two somewhat conflicting suggestions. 1. Try to do only what 
you are comfortable and capable of doing - fix 'em if you can, shunt 'em if you 
can't - and - 2. Dirty Harry's law - A man's (women's) got to know his (her) 
limitations - with Sise's corollary - When you're all alone, the sky's the limit 
- take your best shot.
 
In our civilian trauma centers in our community and, I suspect, around the US 
there is no standard approach to who should repair injured vessels. Two of us on 
our trauma panel are also board certified vascular surgeons with a small 
elective practice and we cover all of our center's vascular injuries. At the 
same time, some of the worst errors I'm asked to review from out of town are the 
tragedies perpetrated by "elective" vascular or cardiovascular surgeons. Some of 
the best work is by general surgery trained trauma surgeons with an interest is 
vascular.
 
Who should perform vascular surgery for trauma and how do we insure quality 
coverage for our patients?
 
Mike Sise
Scripps Mercy Trauma

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