Page 77 - JSOM Fall 2024

An Ongoing Series

Vascular Repair in Wartime Casualties

W. Lachlan Younce, BS ; Justin L. Anderson, BHS *;
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Shane Kronstedt, MD ; Jay Johannigman, MD 4
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ABSTRACT
In the third installment of the “Lest We Forget” series, the au- vessels. However, this often resulted in a high amputation rate
thors discuss a critical advance—vascular repair, pioneered by due to complications from arterial ischemia and venous hy-
Dr. Carl Hughes—in the care of the war-wounded during the pertension, which were considered somewhat unavoidable.
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Korean War. This article reviews the management of large ves- Many factors, both tactical and medical, contributed to this
sel injuries in wartime, the challenges and advances in military treatment paradigm, including prolonged evacuation times,
medicine during the Korean War, and the application of these high rates of surgical site infection due to the austere field
lessons to current practices. conditions and inadequate medical facilities, as well as the
lack of antibiotics. DeBakey and Simeone published an article
Keywords: lest we forget; vascular repair; military medicine highlighting their experience in WWII, detailing the abysmal
success rates associated with the repair of damaged vessels.
Their conclusion, echoing the midcentury consensus, was
Introduction that ligation and amputation were the preferred methods of
treatment. 2
The conclusion of World War II marked a transformative pe-
riod globally. Amid the devastation of war and subsequent Fast forward from the shores of Normandy to the hills of the
rebuilding efforts, a sense of hope and progress emerged. Inchon valley, as the U.S. Military and its medical corps once
Technological advancements flourished, economies recovered, again deployed far forward into austere conditions. Enter
and societies enjoyed unprecedented prosperity. However, a Dr. Carl W. Hughes, a maturing Army medical officer, along
looming sense of conflict persisted in the West, as communism with many other unheralded Army medics, who were willing
began to spread across the East. Tensions rose between the to challenge “doctrine and dictum.” They innovated and im-
ideological blocs of democracy and communism, culminating provised to salvage soldiers and their limbs. Carl W. Hughes,
in the outbreak of the Korean War. born in 1914, grew up on a farm in Eminence, Missouri. He
attended the University of Tennessee School of Medicine, grad-
In this third installment of the “Lest We Forget (LWF)” se- uating in 1944, and immediately began serving as a surgeon
ries, the authors review the advancements in the management for the U.S. Army Medical Corps.
of vascular injuries sustained in the Korean War as described
by Major General (Dr.) Carl Hughes. While some consider After WWII, Dr. Hughes was assigned to work in the Depart-
this conflict a forgotten war in American history, the medical ment of Surgery at Walter Reed. It was here that he began to
advances pioneered during this period had a significant and build his experience treating and repairing vascular injuries.
lasting positive impact on American medicine over the second He developed techniques in vascular surgery that led to bet-
half of the 20th century. The Korean conflict marked the birth ter outcomes. (Authors’ note: It was during this time that Dr.
of vascular surgery, significantly reducing mortality and mor- Hughes also proposed what we now know as REBOA (resus-
bidity among war-wounded and civilian populations, thereby citative endovascular balloon occlusion of the aorta) for the
changing surgical paradigms worldwide. The lessons learned treatment of abdominal bleeds. ) During the Korean War, five
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in the Mobile Army Surgical Hospital (MASH) tents of Ko- MASH units were deployed to the field. Apparently, several
rea must be retained within the constructs of modern military surgeons across many of these units began to develop arte-
medicine as the U.S. military shifts its focus from the Global rial repair techniques using reversed vein grafts. Most of these
War on Terrorism (GWOT) to large-scale combat operations repairs were never formally recorded as it was against Army
(LSCOs) and their inherent challenges. Prior to the Korean policy to do so. Dr. Hughes and his colleagues at Walter Reed
War, soldiers who sustained significant vascular injuries typ- gained experience with managing late complications, such as
ically underwent ligation of the injured arterial and/or venous pseudoaneurysms, associated with these field repairs.

*Correspondence to justin.anderson275@gmail.com
1 W. Lachlan Younce is a student of the Brody School of Medicine at East Carolina University, Greenville, NC. SO-ATP Justin L. Anderson is
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currently pursuing his medical degree at the Duke University School of Medicine, Durham, NC. Dr. Shane Kronstedt is a resident physician in
the Scott Department of Urology at Baylor College of Medicine, Houston, TX. Dr. Jay Johannigman is a professor of surgery at the F. Edward
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Hebert School of Medicine at the Uniformed Services University, Bethesda, MD.
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