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 131
- Downloads 0
Experience with pentotren in patients with obliterating peripheral arteries diseases
The aim — to improve the treatment results of patients with obliterating atherosclerosis of the arteries of the lower extremities. Materials and methods. The examination and treatment results of 50 patients aged 45 to 8...
A combination of minimally invasive treatment for varicose disease of the lower extremities
The aim — to compare the effectiveness of the combined phlebectomy with endovenous laser coagulation (EVLC) with bare‑tip laser fiber and the simultaneous endovenous chemical ablation of the GSV trunk in comparison with...
Influence of small intestine wall changes after electrically welded anastomoses of different types for the anastomotic tensile strength
The aim — to study the effect on the clinical rupture properties of the electric welded anastomosis, the morphological transformations in the wall of the small intestine after the linear and multipoint methods applicati...
The primary diagnostic endoscopic methods for connective tissue diseases verification in patients with respiratory manifestations
The aim — to conduct a retrospective analysis of the connective tissue diseases diagnosis in 47 patients of different ages with respiratory manifestations. Materials and methods. A clinical analysis of the first diagnos...
Analysis of possible complications of phlebosclerobliteration of lower limb veins
A detailed analysis of possible complications after use of phlebosclerobliteration in the treatment of chronic venous insufficiency of lower extremities has been carried out. The latest classifications are presented. The...