Causes of unsatisfactory surgery results of gunshot extremity arterial injuries
Journal Title: Хірургія України - Year 2019, Vol 0, Issue 3
Abstract
The aim — to identify the characteristics of injured persons’ group with limb preservation failure, as well as the factors that led to the limb loss, despite the revascularization attempts, that allows the prognosis and outcome improvement in the injure treatment. Materials and methods. The data on 100 patients who were injured during an anti‑terrorist operation (Joint Forces Operation) in eastern Ukraine between 2014 and May 2019, underwent revascularization for main artery injuries on the extremities, were analysed. Among them were 28 patients with upper limb injuries and 72 patients with lower limb injuries. The amputation was performed in 5 (17.9 %) cases in the group of patients with upper limb injuries, in 12 (17.7 %) patients with lower extremities injuries in the next days or weeks. A cohort of patients with successful revascularization and one with limb loss were analysed. The analysis took into account such wounds’ features as the injury nature, the major soft tissues loss, the evacuation term, the term before specialized care, the accompanying damage to other anatomical structures in the wound area, the presence of combined trauma, the surgery type and condition severity on the moment of evacuation. Results and discussion. The number of prophylactic fasciotomies was lower in the amputee group compared to the group with preserved limbs (35 and 48 %, respectively). The total number of autovenous graft operations in both groups was 51. In 14 (27 %) cases, the amputation was further performed. After prostetic graft (n = 24), 3 (13 %) limb amputations were performed. Conclusions. The most significant factors that led to the unsatisfactory result of revascularization were a major soft tissues loss in the in the wound area, delayed evacuation to a specialized hospital, a severe general condition, concomitant damage to other anatomical structures in the wound area. The most unfavourable prognosis for a reconstructive intervention is a combination of the artery, vein, main nerves, and tubular bone damage («lost limb syndrome»). The choice of a synthetic alloprosthetic for revascularization in gunshot wounds does not increase the risk of further amputation.
Authors and Affiliations
M. V. Shchepetov
Keywords
Related Articles
- EP ID EP670238
- DOI 10.30978/SU2019-3-38
- Views 124
- Downloads 0
Antiseptics solutions efficacy for generalized peritonitis in experiment
The aim — to evaluate experimentally the efficacy of the antiseptic gel solution for peritoneal lavage in generalized peritonitis. Materials and methods. 120 Wistar rats weighing 200 — 250 g were the objects of the expe...
Surgically directed chemotherapy: heated intraperitoneal lavage with a dynamic cytologic control in the complex treatment of pancreatic cancer
The aim — to improve the long‑term treatment results of patients with pancreatic adenocarcinoma at different stages by introducing into the complex therapeutic algorithm of intraoperative and postoperative peritoneal lav...
Dexpro as a strategy for rapid response to pain. What’s new about the known
New data are presented on dexketoprofen tromethamine, an isomeric form of ketoprophenum, which has proven to be an effective and safe analgesic drug, particularly during the perioperative period. The question of the begi...
Classification of surgical instrumentation for removal of foreign bodies embedded in soft tissues
An innovative surgical magnetic and non‑magnetic instrument was proposed, as well as methods for diagnosing and removal of foreign bodies embedded in soft tissues. The proposed classification of surgical instruments allo...
Aloplasty of umbilical hernias with polypropilene mesh modified by antiseptic and carbon nanotubes
The aim — to improve the treatment results of umbilical hernias surgery with modified polypropylene mesh. Materials and methods. The surgical treatment results analysis of 106 patients with umbilical hernias (UH) has be...