Interestingly, effects of war on vascular GANT61 supplier injuries extend after the war. Asfar et al. have shown that penetrating vascular injuries increased in civilian surgical practice after the Second Gulf War reflecting the aftermath of the Gulf War on Kuwait [10]. Mubarak Al-Kabeer Teaching Hospital is a 400 bed hospital located in the centre of Kuwait City. During the Second Gulf War, fighting occurred close to the hospital leading to a short evacuation time. This gave us a unique opportunity for treating vascular injuries in multiply severe injured

patients similar to a front line field hospital. [4]. We aimed to study the biomechanism, pattern of injury, magnitude, and outcome of vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second

Gulf War and to highlight lessons mTOR inhibitor learned from that period. Patients and methods All war-related injured patients who had vascular Epigenetics inhibitor injury and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. During the study period Mubarak Al-Kabeer Teaching Hospital received more than 1100 war-injured patients out of whom 361 patients were admitted. Data were retrieved from the Gulf War Injury Database which was retrospectively collected. A special form was designed to collect the data. Data were coded and an Access Program was used to design the database. Studied variables included age, gender, site of vascular injury, mechanism of injury, associated trauma, type of vascular repairs, and clinical outcome. Comminuted/complicated open fractures were primarily managed by external fixators. Data were analyzed with the PASW Statistics 18, SPSS Inc, USA. Data were presented as mean (SD), median (range) or numbers (%) as appropriate. Results There were a total of 36 patients with major vascular injuries during the study period. This constituted 10% (36/361) of all war-related hospitalized patients while 32 (89%) were males. Their mean (SD) age was 29.8 (10.2) years. 21 (58%) were civilian and 15 (42%) were soldiers.

Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%) (Table 1). Thirteen patients were Iraqi (36%), 11 were Kuwaiti (31%) and 12 were from other nationalities. Eight patients (22%) presented with shock on arrival to the hospital. Table 1 Mechanism of vascular injuries Cause of injury Number % Bullet (-)-p-Bromotetramisole Oxalate injury 17 47.2 Blast injury 17 47.2 Stab wound 2 5.6 Total 36 100% Table 2 shows the anatomical distribution of injuries. Majority of patients had head and neck injuries beside the extremity injuries. Only 2.8% had chest trauma. Table 2 Distribution of injuries of patients having vascular war-related injuries, n = 36, August 1990 to September 1991, Mubarak Hospital, Kuwait Region Number % Head and neck 7 19.4% Chest 1 2.8% Abdomen and pelvis 3 8.3% Upper limbs 8 22% Lower limbs 21 58% Type of arterial injury and their operative management are shown in Table 3.