Experience in the management of extremity vascular injuries in a Civilian Multidisciplinary Hospital in a Combat-Related Area

Background. Modern military conflicts are characterized by a significant number of wounded with injuries to the main arteries of the limbs. Such injuries are associated with a potentially fatal outcome and a high risk of limb amputation. Treatment of wounds to large arteries requires highly qualified medical personnel and sufficient equipment. Optimal tactics remain a subject of debate. The aim of this study was to determine the specifics of surgical tactics for injuries to major arteries in a civilian hospital setting in an area near combat operations. Methods: The treatment outcomes of 57 patients with combat wounds to the major arteries of the extremities were analyzed. The immediate results of arterial restoration were monitored for at least two days. The variety of injury manifestations was demonstrated in eight clinical cases. Surgical tactics were determined by the degree of muscle ischemia and the extent of tissue damage to the limb. Amputations were performed when ischemic contractures developed or significant tissue damage to the limb occurred. Results: Arterial resection with autovenous grafting was performed in 49 patients, and circular arterial resection with direct anastomosis was performed in 8 patients. In the immediate postoperative period (the first two days), extracorporeal detoxification was required in 5 patients (9%) due to postischemic syndrome. Peripheral blood flow was restored in 56 patients (98.2%), and secondary lower limb amputation was performed in only one patient (1.8%). There was no mortality (0%). Conclusion. In a modern military conflict, the line of contact may be located in close proximity to well-equipped civilian healthcare facilities providing high-tech medical care. However, in the case of complex surgical procedures, it is advisable to organize immediate patient monitoring on-site and refrain from immediate evacuation. In the case of a major artery injury to a limb, the degree of muscle ischemia is the main parameter influencing the possibility of limb salvage. Irreversible ischemia is often difficult to diagnose, and the primary focus should be on the development of ischemic contracture. The time of injury, the absence of a pulse, active movement, and sensation are not indications for amputation. The algorithm we developed has proven highly effective.