gms | German Medical Science

Background: Gunshot wounds (GSW) of the main vessels remain relevant and sophisticated sphere of vascular surgery both, in therapeutic and organizational way.

Methods: The patient was admitted to the vascular surgery clinic with a diagnosis: Gunshot bullet penetrating wound of soft tissues of the left popliteal area (08.08.21.) with damage to the popliteal artery and vein, posterior tibial nerve, with complaints of severe pain in the left leg, swelling of the limb, wounds in the lower leg, general weakness.

Treatment: First aid was provided at the scene: a tourniquet was applied to the hip. He was evacuated to the military hospital in Khurahovo, where permed surgical treatment of wounds, prothesis of the popliteal artery with PTFE, ligation of the popliteal vein, fasciotomy. 08.09.21 – evacuated to the NMMCC, where were performed: Revision of the vascular bundle of the left leg, repeated surgery, removal of the long tibialis muscle, partial resection of a deep portion of the soleus muscle of the left leg (10.08.21); Repeated surgical treatment of wounds (RSTW), partial resection of necrotic muscles of the left leg (12.08.21); RSTW, removal of the anterior tibialis muscle, partial resection of necrotic muscles of the left leg (14.08.21); RSTW, installation of VAC-system on wounds of the left leg (16.–21.08.21); Wound revision, refurbishment, secondary suturing of wounds (31.08.21).

Figure 1 [Fig. 1], Figure 2 [Fig. 2], Figure 3 [Fig. 3]

Results: After treatment the state of blood circulation of the lower extremities is compensated. The skin is pale pink, warm to the touch, sensitivity and motor function are preserved, pulsation is determined on the arteries of the feet, swelling of the left leg stiffness, wounds healed under the sutures, sutures removed.

Conclusion: According to world statistics, modern wars differ in significantly higher rates of major vessels’ gunshot wounds than those in the wars of the late XX to early XXI centuries (World War II, Korea and Vietnam) (12% vs. 2.8–8%), and the proportion of vessel gunshot wounds of the lower extremities is constantly growing. All wounded with CGW at the 4^th stage of medical evacuation are mostly severe due to complications after the previous stages of evacuation and due to a combination of injuries in other arterial basins, other organs, which required multiple surgeries, sometimes with loss of limb. The high level of surgical care at the 4^th stage of medical evacuation in Ukraine, the completeness of modern medical support of mainly domestic manufacturers and the use of state-of-the-art technologies permit to avoid mortality in this category of wounded.