War injuries of the crural arteries

Abstract

Twenty-eight patients with military crural vascular injuries are presented. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 min). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3-47 (mean 14) days. Hyperbaric oxygenation therapy was used in conjunction with surgery and antibiotic therapy in 13 of the 28 patients. Explosive injuries were found in 14 patients and high-velocity missile injuries in nine; associated fractures were present in 20. Twenty of the 28 patients with crural vascular injuries had combined arterial and venous injuries, while eight had isolated arterial injuries. Twenty-five patients with distal ischaemia required arterial repair; five late amputations resulted. Military crural vascular injuries should be treated with soft tissue debridement, removal of foreign material, and microvascular arterial and concomitant vein reconstruction. This should be followed by external skeletal stabilization for bony and/or soft tissue instability, with fasciotomy for any associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric oxygen therapy reduced the amputation rate following combat-related crural vessel injuries.

Adjuvant Hyperbaric Oxygen Therapy in the Management of Crush Injury and Traumatic Ischemia: An Evidence-Based Approach

“…Only eight of them met the inclusion criteria. [15][16][17][18][19][20][21][22] We also found one meeting abstract 23 that provided enough information for evaluation. Eight of the nine documents evaluated were class III and one was class I (Table 1).…”

“…Radonic et al 20 presented their experience of 28 patients with combat-related crural vascular injuries during the Croatian war. The mechanism was penetrating in all cases.…”

Triple vessel injury with single penetrating trauma to the lower extremity requiring popliteal to posterior tibial artery bypass

“…This emphasizes the need for frequent neurovascular checks in such patients, especially when multiple procedures are necessary. Delay in deterioration of vascular exam can take place over a period of time of variable length, ranging from several hours up to three weeks [ [6] , [7] , [8] ]. This indicates the need for close follow up and even outpatient screening after discharge.…”

Infektionsprophylaxe bei Kriegsverletzungen

“…In verschiedenen Konflikten jüngerer Zeit finden sich Beispiele für den erfolgreichen prophylaktischen und therapeutischen Einsatz von Antibiotika, u. a. im Vietnam-Krieg (Prophylaxe bei 70 % aller Verwundeten) [14], Libanon 1982 [27], Afghanistan [2], Golf-Krieg, Kurtina/Kroatien [20] oder Split [26].…”

“…In bewaffneten Konflikten ergeben sich Situationen, in denen moderne medizinische Leitlinien oft nicht haltbar sind [26]. Die chirurgische Therapie und postoperative Pflege werden häufig limitiert und durch widrige Umstände (z.…”