Table 2

Advanced course for deployment surgery content

Didactic lecturesPractical workshops
Module 1Comprehensive overview on war wounded and organisation of the FMHS during deployment abroad
  • ▸ War wounded: epidemiology, initial support, principles of damage-control surgery, special features of wounding agents, rules of triage and use of antibiotics in war wounds

  • ▸ Organisation of the FMHS: levels of care, rules, principles of tactical and strategic aeromedical evacuation and health products supply

  • ▸ Officer's course in foreign deployment, legal concerns on the battlefield

Demonstration and handling of technical equipment
  • ▸ Presentation and assembling of an FST housed in tents

  • ▸ Demonstration and handling of the equipments available in the FSTs (surgical equipment, principles of sterilisation and radiology)

Module 2Management of limb and soft tissues injuries
  • ▸ Burns: types of burns, dressing, escharotomy, fasciotomy, excision and skin grafting

  • ▸ Soft tissue injuries: principles of debridement and negative pressure wound therapy

  • ▸ Upper and lower extremity injuries: management of penetrating injuries, closed fractures and landmine foot

  • ▸ Vascular injuries: epidemiology, diagnostic tools and choice of adequate treatment

  • ▸ Compartment syndrome: therapeutic and preventive indications

Practical sessions on cadavers
  • ▸ Wound debridement, skin grafting (manually operated dermatome), negative pressure wound therapy dressings, basic pedicle flap transfers and limb amputation

  • ▸ Upper and lower extremity external fixation with PercyFx

  • ▸ Upper and lower limb arteries approach (axillary, humeral, iliac, femoral and popliteal arteries)

  • ▸ Fasciotomy (leg 4 compartments, forearm and hand)

Module 3Management of head, neck, cervical spine and thoracic injuries
  • ▸ Craniocerebral wounds and cranial trauma

  • ▸ Spinal cord, ocular, face and neck injuries

  • ▸ Wounds of the neck, larynx, trachea and oesophagus

  • ▸ Open and closed thoracic injuries: indications and management of chest drainage and emergency thoracotomy

Practical sessions on cadavers
  • ▸ Skull and face: burr hole trepanation, craniotomy, nasal packing for epistaxis and intermaxillary blocking

  • ▸ Neck: cricothyrotomy, tracheotomy, subclavian and carotid arteries approach

  • ▸ Thorax: anterolateral and clamshell thoracotomies, sternotomy, vascular control of descending thoracic aorta and cross-clamping, vascular control of major branches of the aortic arch and subxiphoid pericardial window

  • ▸ Enucleation of the eye

Module 4Management of abdominal and pelvic injuries, eFAST
  • ▸ Thoracoabdominal injuries: penetrating and closed injuries, haemorrhagic shock, damage-control resuscitation and liver, spleen, kidney, duodenum, pancreas and digestive injuries

  • ▸ Pelvic injuries: abdomino-pelvic-gluteal injuries, bladder, ureteral and urethral injuries and closed pelvic fracture

  • ▸ Basis of eFAST

Practical sessions on cadavers
  • ▸ Abdomen: organs approach, mobilisation and fascia separation, Pringle manoeuvre, perihepatic packing, vascular control of aorta and inferior vena cava, splenectomy, colostomy and laparotomy with negative pressure wound therapy dressings

  • ▸ Pelvis: suprapubic cystostomy, ureteral double-J stent set up, pelvic external fixation, pelvic packing and internal iliac artery ligation

  • ▸ eFAST: hands-on sessions between students

Module 5Medical support to populations and management of major haemorrhage
  • ▸ Reminder of severe abdominal (module 4), thoracic (module 3) and vascular (module 2) haemorrhage management

  • ▸ Medical support to populations in austere environment: principles, ethics and specificity of care

Practical sessions on swine
  • ▸ Temporary repair of haemorrhagic injuries: direct pressure, packing, vascular control and temporary shunt

  • ▸ Definitive repair of haemorrhagic injuries: vascular repair and end-to-end anastomosis, venous bypass graft, suture of a lesion of inferior vena cava or portal vein and suture of a wound to the heart

  • ▸ Laparotomy with negative pressure wound therapy dressing at the end of procedure

  • eFAST, extended Focused Assessment with Sonography for Trauma; FMHS, French Military Health Service; FST, Forward Surgical Team.