Course Goal

• The primary goal of the ASSET course is to master the rapid, safe anatomical exposure of major vascular and visceral structures necessary for the definitive management of acute, life-threatening traumatic injuries.

Cognitive Objectives (Knowledge)

• Identify major anatomical landmarks and relationships required for rapid exposure of central and peripheral vascular structures under emergent conditions.

• Sequentially outline the steps for formal exposures of the neck, chest, abdomen, and extremities.

• Anticipate the specific surgical instruments and exposure adjuncts (e.g., self-retaining retractors, vascular clamps) required for complex trauma exposures.

• Explain the anatomical hazards and adjacent structures at risk of iatrogenic injury during rapid dissection fields.

Technical & Psychomotor Objectives

• Neck Exposure: Perform rapid exposure of the carotid sheath, internal/external carotid arteries, internal jugular vein, and the trachea/esophagus.

• Thoracic Exposure: Demonstrate standard left anterolateral thoracotomy and median sternotomy, including exposure of the internal mammary vessels and the superior mediastinum.

• Abdominal Exposure: Execute a rapid midline laparotomy, standard four-quadrant packing, and formal exposure of the retroperitoneum via zone-specific maneuvers (Cattell-Braasch and Mattox maneuvers).

• Vascular Control: Safely isolate and gain proximal and distal control of major vessels, including the infrarenal and suprarenal abdominal aorta, inferior vena cava, and portal triad (Pringle maneuver).

• Extremity Exposure: Safely expose the axillary/brachial vessels in the upper extremity and the femoral/popliteal vessels in the lower extremity.

Affective & Communication Objectives

• Demonstrate a systematic, calm approach to anatomical dissection when dealing with high-stress, simulated exsanguinating hemorrhage.

• Recognize limits of exposure and articulate when a standard incision must be extended or converted (e.g., extensions from a thoracotomy to a sternotomy) to achieve adequate visualization.

1. Lab 1 - Exposure of Injuries to the Neck and Upper Extremities

   • Perform a cricothyroidotomy. 

   • Expose the contents of the carotid sheath. 

   • Expose and control the axillary artery. 

   • Expose and repair the cervical esophagus. 

   • Expose and repair the cervical trachea. 

   • Expose and control the subclavian artery through a supraclavicular incision. 

   • Expose and control the brachial artery. 

   • Perform forearm fasciotomies. 

2. Lab 2 - Exposure of the Lower Extremities and Pelvis

   • Expose and control the femoral artery. 

   • Expose and control the above and below knee popliteal artery.

   • Expose and control the SFA and practice temporary vascular shunting. 

   • Perform four compartment fasciotomies of the lower extremity. 

   • Perform thigh fasciotomy.

   • Perform retroperitoneal exposure of the iliac vessels. 

   • Perform preperitoneal pelvic packing. 

   • Discuss REBOA use.

3. Lab 3 - Exposure of Injuries to the Chest

   • Perform a median sternotomy. 

   • Perform cardiac injury repairs. 

   • Practice sternal closure.

   • Perform a resuscitative left anterior thoracotomy. 

   • Perform a clamshell thoracotomy and gain control of the great vessels. 

   • Perform pulmonary tractotomy and hilar control.

   • Perform a trapdoor incision for left subclavian vascular repair. 

4. Lab 4 - Exposure of Injuries to the Abdomen

   • Perform a trauma laparotomy. 

   • Perform a splenectomy. 

   • Perform supraceliac aortic control. 

   • Perform a left-to-right medial visceral rotation. 

   • Gain infrarenal aortic control through the root of the mesentery. 

   • Perform a right-to-left medial visceral rotation. 

   • Practice hepatic packing and repair followed by total hepatic exclusion. 

• ASSET Course:

  • Advanced Surgical Skills for Exposure in Trauma | ACS 

• Access Surgery through the UA Health Sciences Library (see below on how to navigate to the videos required for review)

  • Health Sciences Library | University of Arizona Libraries