Main Military Medical Clinical Center «Main Military Clinical Hospital», Kyiv, Ukraine.
National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
World J Surg. 2022 Jul;46(7):1625-1628. doi: 10.1007/s00268-022-06577-y. Epub 2022 Apr 28.
The incidence of vascular damage in modern combat conflicts is 5 times higher than in previous military conflicts, with one in five wounded having uncontrolled severe blood loss. Treatment of gunshot wounds of the main arteries is a complex multi-level process, which can be done only in the case of close cooperation of related surgical specialties.
This case report details treatment of a 40-year-old man who was admitted with a gunshot wound to the left shoulder with injury of the distal axillary and proximal brachial arteries. Primary surgical treatment consisted of venous interposition graft of the injured artery and debridement of the scapular wounds in a peripheral hospital. He was transferred to Main Military Medical Clinical Center in Kyiv with acute thrombosis of the vascular repair graft. Urgent reoperation was performed, with removal of the previously placed vascular graft and revascularization of the distal axillary and proximal brachial artery with reverse venous graft, with accompanying fasciotomy.
This case demonstrates the crucial role of rapid evacuation of wounded to a specialized level of care for complex cases such as arterial reconstruction.
现代战斗冲突中血管损伤的发生率比以往的军事冲突高 5 倍，每 5 名伤员中就有 1 人发生无法控制的严重失血。主要动脉枪伤的治疗是一个复杂的多层次过程，只有在相关外科专业密切合作的情况下才能进行。
本病例报告详细介绍了一名 40 岁男性的治疗情况，他因左肩枪伤就诊，伴有腋动脉远端和肱动脉近端损伤。在一家外周医院进行了初步手术治疗，包括静脉间置移植修复损伤的动脉和肩胛部伤口清创术。他因血管修复移植物急性血栓形成被转至基辅主要军事医疗临床中心。紧急再次手术，取出先前放置的血管移植物，用逆行静脉移植物重建腋动脉远端和肱动脉近端，并伴随筋膜切开术。
本病例表明，对于复杂病例（如动脉重建），迅速将伤员转移到专门的治疗水平至关重要。
