Extracorporeal sheath shunt technique in trauma: A different vascular shunt in civilian trauma

Background/Objective Temporary intravascular shunts are widely used in military surgery, representing a bridging until definitive vascular reconstruction. In civilian practice, shunts are mainly used as damage control and as a temporary measure until orthopaedic fixation. The objective of this report is to illustrate a new approach to the temporary restoration of perfusion during open management of extremity arterial injury. Methods The authors present a technique that uses sheaths introducers, instead of commercial or purpose-built shunts, which can be used through surgical or percutaneous approaches. Three clinical cases are presented where this technique was performed. Results/Conclusion: In the presented cases, this technique reduced time of shunt construction by avoiding artery surgical approach. This technique can facilitate the creation of an intravascular shunt among other than vascular surgeons.

Yakov Stechkin: Portrait of a Provincial Surgeon in the Realities of the 1920s

The article provides an analysis of professional formation and conditions of development of practical medicine in a provincial city of central Russia in the 1920s. For the first time, the authors introduce materials from the personal archive of surgeon Yakov Sergeyevich Stechkin, the brother and father of famous constructors Boris and Igor Stechkin. Yakov Stechkin practiced in Aleksin in 1922–1935. Based on statistical reports from his personal archive, the article reveals the peculiarities of provincial surgery. It analyzes such features as the range of operations performed, the use of anesthesia, and the level of lethality. Main attention is paid to the analysis of the mutual interweaving and transformation of various professional and cultural components in the activity of an ordinary physician: the traditions of zemstvo medicine, military surgery, and Soviet medicine of the 1920s. Each of these components made a contribution to behavioral models of the provincial doctor. Traditions of medicine with its principles of accessibility and free service correlated with the declared norms of Soviet health care system, versatility of military surgeon was more than necessary in terms of personnel lack, while material devastation was offset by broad professional freedom, permeated with the atmosphere of research and experimentation. Based on the memoir sources, the authors show the specific ways of communication between a doctor and his patients, typical of a small provincial town. The authors of put particular emphasis on the fact that an ordinary provincial surgeon resorted to trends of the time, such as experiments in eugenics, endocrinology, and rejuvenation. The article highlights factors that led the Russian physician, who treated the power of the Bolsheviks without reverence, to be integrated into the Soviet health care system.

Surgeon-innovator and physician-humanist ahead of his time (to the 145th anniversary of the birth of academician A.V. Vishnevsky)

The main scientific and practical activities of A.V. Vishnevsky took place in Kazan and Moscow. This paper presents little-known facts from the creative life of A.V. Vishnevsky, with a focus on his contribution to the development of local anesthesia and novocaine blockade in our country. Vishnevsky graduated from the Astrakhan gymnasium in 1894 and from the Kazan University in 1899. From 1899 to 1912, he was an assistant dissector at the departments of normal anatomy, topographic anatomy, and operative surgery of Kazan University. During the First World War, he mostly performed surgery to wounded individuals with gunshot injuries that involved peripheral nerves, producing neurolysis or suturing of the nerves. To treat brain abscesses, he used oil-balsamic drainage, which gave better results than other therapeutic methods. From 1914 to 1934, he managed first the hospital and then the faculty surgical clinics in Kazan. With the emerging problems in surgery, he paid much attention to neurosurgery, local analgesia, suppurative processes, nervous tropism, and gunshot wounds. His original theoretical works were devoted to neural trophy. His proposed methods of nerve block, in particular, pericardial novocainic and vago-sympathetic blockages, were widely accepted. As regards his contribution to the field of military surgery, he promoted proper surgical treatment of wounds, justified secondary treatment of wounds, and suggested methods to combat traumatic shock, secondary bleeding, etc. In 1947, A.V. Vishnevsky was appointed as the Director of the Institute of Surgery of the USSR Academy of Medical Sciences in Moscow. He was the founder of the great national school of surgeons.

Edward D. Churchill (1895-1972): An Innovative Surgeon, His Work, and His Contribution to Parathyroid Surgery

Edward Delos Churchill, one of the most notorious American surgeons of the 20th century, influenced countless surgeons and set medical practices that were used for decades. His scope of interests included surgery of the lungs, heart, thyroid, parathyroid glands, and military surgery among others. Churchill was one of the first to expand the field of the newly found parathyroid bodies by performing several experimental excisions of the glands and publishing numerous guidelines based on his innovative work. Additionally, he aspired to address many of the literature gaps that led him to conclusions that would benefit both the surgeons and patients throughout the country. Most importantly, his deep interest in endocrinology and his aggregate approach of medicine led him to discoveries that paved the way to the modern endocrine surgery practices.

Evaluation of a fellowship abroad as part of the initial training of the French military surgeon

IntroductionMilitary surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment.MethodsThis study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents’ first foreign deployment.ResultsSixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10.ConclusionA fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees’ feedback confirms its relevance.