War surgical repair of arterial injuries by using anterior rectus sheath graft
the intention of this letter is to report how we performed surgery on the spot, under war and battle conditions. The aim is not to teach, propose, make surgical strategy or even doctrine. Just to report how it was done, ON THE SPOT, during the last war in Croatia. This is a war surgeon’s report of experimental and clinical experiences using the anterior rectus sheath graft (the strongest membrane in the human body) as a patch for repair of great arteries injured under war conditions. Such injuries are primarily contaminated and the use of xenografts can be dangerous due to infection. The rectus sheath patch as a potentially growing material was used for repair of congenital heart lesions as atrial septal defect (ASD) primum type. Experimentally, in sheep, the rectus sheath graft was used for repair of femoral arterial artificial lesions. After six months the affected vessels were histologically examined. In both models, animal and human, so far hasn’t been observed: early bleeding from rectus sheath patches, infection, aneurysmal dilatation or scar contraction. No manifestation of peripheral emboli was seen as well as no aneurysmal formations, rupture, calcifications or deformations. On the contrary, so far the covering of the lumen by vascular endothelium, laminations of media, formation of serosa layer elements and vascularization of the graft and adventitia like tissue have been observed and reported. During the Croatian War of Independence this kind of surgical repair has been applied on 184 patients with excellent results.
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