Development of an emergency general surgery process improvement program.

Background: The Joint Trauma System has demonstrated improved outcomes through coordinated research and process improvement programs. With fewer combat trauma patients, our military American College of Surgeons level 2 trauma center's ability to maintain a strong trauma Process Improvement (PI) program has become difficult. As emergency general surgery (EGS) patients are similar to trauma patients, our Trauma and Acute Care Surgery (TACS) service developed an EGS PI program analogous to what is done in trauma.

Metalloproteinase expression is associated with traumatic wound failure.

Background: Matrix metalloproteinases (MMPs) are crucial in the inflammatory and remodeling phases of wound healing. We previously reported the correlation between pro-inflammatory cytokines and timing of successful combat-wound closure. We now extend our studies to investigate the correlation between wound-remodeling MMP expression and wound healing.

Inflammatory biomarkers in combat wound healing.

Background: Modern war ballistics and blast injuries inflict devastating extremity injuries, violating soft tissue, bone, and neurovascular structures. Despite advances in complex wound management, appropriate timing of war wound closure remains subjective. In addition, the pathophysiology of acute wound failure is poorly defined.

Transforming an academic military treatment facility into a trauma center: lessons learned from Operation Iraqi Freedom.

Background: To manage the influx of patients with predominately extremity injuries from Operation Iraqi Freedom (OIF), our center was required to transform from a nontrauma academic hospital to a trauma hospital by using a multidisciplinary approach.

Study Design: A retrospective chart review was performed of casualties from OIF who were received over 14 months.

Results: A total of 313 casualties were received.

Perioperative blood transfusion in combat casualties: a pilot study.

Background: In recent studies, blood transfusion has been shown to increase the rate of wound healing disturbances in orthopedic patients. Furthermore, our group has determined a correlation between delayed wound healing and elevations in inflammatory mediators in combat casualties. Therefore, we sought to determine the effect of blood transfusion on wound healing and inflammatory mediator release in combat casualties.

Management of colorectal injuries during operation iraqi freedom: patterns of stoma usage.

Background: Management of penetrating colorectal injuries in the civilian trauma population has evolved away from diversionary stoma into primary repair or resection and primary anastomosis. With this in mind, we evaluated how injuries to the colon and rectum were managed in the ongoing war in Iraq.

Methods: The records of Operation Iraqi Freedom patients evacuated to National Naval Medical Center (NNMC) from March 2004 until November 2005 were retrospectively reviewed.

Femoral vessel injuries in modern warfare since Vietnam.

The incidence of lower extremity injuries is high in modern warfare; however the mortality rate from these injuries is low. Despite the overall low mortality of lower extremity injuries, many deaths in modern conflicts are due to femoral vessel injury. The modern warfare literature was reviewed.