The experience of treating battle injuries of the magistral arteries in the limbs in the settings of the civilian multi-profile in-patient hospital

BACKGROUND: The modern military conflict is characterized by a significant number of wounded with the damage of the magistral arteries in the limbs. Such an injury is accompanied by the possibility of lethal outcome and by the high risk of limb amputation. The treatment of the injuries in the major arteries requires high qualification of the medical staff and sufficient equipment basis. The optimal tactics for this still remains the matter of discussion. AIM: to define the specific features of the surgical tactics in cases of injured magistral arteries in the settings of the civilian specialized in-patient hospital in the regions adjacent to the scene of military operations. METHODS: The analyzed data included the treatment results in 57 patients with battle injuries of the magistral arteries in the limbs, in which we have managed to track the direct result of restoring the arteries within not less than two days. The variety of manifestations observed in cases of injuries was demonstrated using 8 clinical cases. The surgical tactics was defined by the degree of ischemia in the muscles and the extent of damaging the tissues in the limb. Amputations were conducted in cases of developing the ischemic contracture or in cases of significantly damaged limb tissues. RESULTS: The resection of the artery with autovenous prosthetic replacement was done in 49 cases, while the circular resection of the artery with the direct anastomosis — in 8 cases. Within the earliest post-surgery period (first two days) due to the post-ischemic syndrome, the usage of the extracorporeal detoxication methods was required in 5 (9%) wounded. The restoration of the peripheral circulation was observed in 56 (98.2%) cases, the secondary amputation of the lower limb was done only in 1 (1.8%) operated patient. No fatal outcomes were reported (0%). CONCLUSION: In the modern military conflict, the battle contact line can be located in the direct proximity from the well-equipped civilian healthcare institutions, at the premises of which the high-tech medical aid is accessible. Our experience shows that, in case of performing the complex surgeries, the follow-up within the early period is practicable to be organized at the site with avoiding the immediate evacuation. In cases of damaging the magistral artery in the limb, the main parameter affecting the possibility of saving the limb itself, is the degree of ischemia in the muscles. The irreversible ischemia is often hard to define and the development of the ischemic contracture should be taken as the guidance. The time of injury, the absence of pulse, of the active movements or sensitivity cannot serve as an indication for amputation. The algorithm developed by us has shown its high efficiency.