Treatment of patients with gunshot traumatic amputations of the lower limbs due to explosive injury in the conditions of today’s war in Ukraine

Abstract

Annotation. In the conditions of today's war, limb injuries due to explosive injuries and wounds reach 63.9%, of which gunshot traumatic limb amputations account for an average of 5.0%. The goal is to analyze the results of the treatment of the wounded with gunshot traumatic amputations of the lower limbs in case of an explosive injury and to identify their shortcomings and propose ways to eliminate them. The results of treatment of 306 patients with traumatic amputations of the lower limbs from February 24, 2022 to August 1, 2023 were analyzed. Complete detachment of the limb occurred in 162 patients, massive destruction of the limb with soft tissue defects – in 79, and explosive injury of the limb with damage to the main vessels with the subsequent development of decompensated ischemia, which required amputation – in 48, wounded with prolonged tourniquet time, which led to irreversible changes in the limb – in 17 cases. At the third level of medical care, 105 patients were operated on urgently. The reasons were damage to the main vessels of the limb, which led to decompensated ischemia of the limb in 28 cases, pronounced necrotic changes of the stump of the limb – in 67, and erosive bleeding – in 8. 201 patients underwent planned surgery in the form of radical complex repeated (secondary) surgical treatment of defects of the tissues of amputated limb stumps. In the early postoperative period suppuration of amputation stumps occurred in 67 patients, bleeding occurred in 8. In the late postoperative period defective stumps were observed in 23, ligature fistulas – in 9, osteophytes – in 4, neurilemmoma formation – in 6 patients. Thus, purulent-inflammatory complications associated with non-radical primary surgical treatment, suturing of tissues for the formation of a stump, by increasing the time interval between surgical treatments. Primary surgical treatment should be radical without suturing the limb stump. For their prevention and treatment at the tertiary level, it is advisable to use the proposed radical complex repeated (secondary) surgical treatment.