{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T11:16:25Z","timestamp":1780053385836,"version":"3.54.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"7-8","funder":[{"DOI":"10.13039\/100014044","name":"59th Medical Wing","doi-asserted-by":"publisher","award":["FWH20120044A"],"award-info":[{"award-number":["FWH20120044A"]}],"id":[{"id":"10.13039\/100014044","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Energized ballistic fragments from improvised explosive devices were the most common cause of injury to coalition service personnel during conflicts in Iraq and Afghanistan. Surgical excision of retained fragments is not routinely performed unless there is a concern for injury to vital structures. However, no clear guidelines dictate when or if a fragment should be removed, reflecting a lack of objective evidence of their long-term effects. Using a porcine model, we aimed to evaluate changes to the carotid artery produced by retained fragments over time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Institutional Animal Care and Use Committee approval for all experiments was obtained before commencement of the study. Eighteen female swine (mean mass 62.0\u2009\u00b1\u20093.4\u2009kg) were randomized into three study groups corresponding to the time of survival after implantation of ballistic fragments: 1, 6, and 12\u2009weeks. Two animals from each group were randomly assigned to have one of the three different fragments implanted within the right carotid sheath in zones 1-3 of the neck. The left carotid served as the control. The vascular flow rate and arterial diameter were measured at each level before implantation and again after the survival interval. Baseline and interval angiograms were performed to identify gross vascular changes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>No abnormalities were identified on baseline or interval angiograms. No significant difference was found when the baseline was compared to interval measurements or when compared to the control side for all gross and physiological measures at 1 and 6\u2009weeks (P\u2009=\u2009.053-.855). After 12\u2009weeks, the flow and diameter changed significantly (P\u2009&amp;lt;\u2009.001-.03), but this significant change was found in both the control and affected carotid.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The lack of significant gross anatomical and physiological changes at 6\u2009weeks postimplantation lends evidence toward the current policy that early removal of retained ballistic fragments around cervical vessels is not required. Changes were significant after 12\u2009weeks which suggest that surveillance may be required; however, such changes could be explained by physiological animal growth.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usac276","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T11:58:21Z","timestamp":1664452701000},"page":"e1774-e1780","source":"Crossref","is-referenced-by-count":1,"title":["Local Effect of Ballistic Fragments Embedded Along the Carotid Sheath of a Porcine Animal Model"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0536-8886","authenticated-orcid":false,"given":"Kathleen M","family":"Sarber","sequence":"first","affiliation":[{"name":"Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Department of Otolaryngology-Head and Neck Surgery, 59th Medical Group , Lackland AFB, TX 78236, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Mid Coast Hospital \u2013 MaineHealth , Brunswick, ME 04011, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik K","family":"Weitzel","sequence":"additional","affiliation":[{"name":"Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Operational Medicine, Wilford Hall Ambulatory Surgical Center , Lackland AFB, TX 78236, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayne","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, 59th Medical Group , Lackland AFB, TX 78236, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K","family":"Aden","sequence":"additional","affiliation":[{"name":"Department of Graduate Medical Education, Brooke Army Medical Center , Ft Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Breeze","sequence":"additional","affiliation":[{"name":"Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Level 2 Queen Elizabeth Hospital , Birmingham B15 2TH, 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