• Pieter W Stark, Borger van der BurgBoudewijn L SBLS0000-0002-1199-4042Department of Surgery, Alrijne Hospital, Leiderdorp, South Holland 2353 GA, The Netherlands., van DongenThijs T C FTTCF0000-0001-8172-5545Department of Surgery, Alrijne Hospital, Leiderdorp, South Holland 2353 GA, The Netherlands.Ministry of Defense, Defense Healthcare Organization, Den Haag, South Holland 2511 CB, The Netherlands., Marnalg Casper, WouterMinistry of Defense, Defense Healthcare Organization, Den Haag, South Holland 2511 CB, The Netherlands., and Rigo Hoencamp.
• Trauma Research Unit, Department of Surgery, Erasmus MC University Hospital, Rotterdam, South Holland 3015 GD, The Netherlands.
• Mil Med. 2024 Jul 3; 189 (7-8): e1668e1674e1668-e1674.

IntroductionThe primary aim of this randomized controlled trial was to assess if a head-mounted display (HMD) providing telemedicine support improves performance of a two-incision lower leg fasciotomy by a NATO special operations combat medic (combat medic).Materials And MethodsThirty-six combat medics were randomized into two groups: One group performed a two-incision lower leg fasciotomy with the assistance of an HMD, while the control group completed the procedure without guidance. A Mann-Whitney U test was used to determine the possible differences in release of compartments and performance scores, as assessed by a supervising medical specialist. A Fisher's exact test was used to compare the proportions of collateral damage between groups. An independent-samples t-test was used to interpret total procedure times. The usability and technical factors involving HMD utilization were also assessed.ResultsCombat medics in the HMD group released the anterior compartment (P ≤ .001) and deep posterior compartment (P = .008) significantly better. There was significantly more iatrogenic muscle (P ≤ .001) and venous damage (P ≤ .001) in the control group. The overall performance of combat medics in the HMD group was significantly better than that of the control group (P < .001). Combat medics in the control group were significantly faster (P = .012). The combat medics were very satisfied with the HMD. The HMD showed no major technical errors.ConclusionsThis randomized controlled trial shows that a HMD providing telemedicine support leads to significantly better performance of a two-incision lower leg fasciotomy by a combat medic with less iatrogenic muscle and venous damage.© The Association of Military Surgeons of the United States 2023.

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