ADDITIONAL VASCULAR CONSIDERATIONS

If the DCBI is associated with a venous injury: iliac or common femoral; these injuries should be shunted or repaired rather than ligated, to preserve venous outflow. Unless easily repairable, arterial injuries in these critically injured patients should be managed initially with shunting followed by formal repair at subsequent operation within 12 -24 hours depending upon patient stability.24 During the index operation, restoring inflow is critical and restoring outflow is optimal. Even if the venous shunt goes down, or the vein clots after repair, the initial restoration of outflow is beneficial for the remaining tissue. If there are viable limbs and muscle contained by fascial compartments, fasciotomies are necessary as compartment syndrome can occur even in the presence of large open wounds if the fascia remains intact.

Refer to JTS Vascular Injury and Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds CPGs for further guidance.24,19