ABSTRACT

Background and Aims:

The aim of this paper is to convey lessons learned from the high velocity missile related severity of combat vascular injuries.

Material and Methods:

The study was designed as retrospective case series in order to overcome difficulties associated with confounding factors. Clinical and objective data (case photographs, x-rays, and CT scans) were thoroughly reviewed. Noncombat related injuries, as such accidental injuries (falls, car crash, etc.) were excluded and only explosives and high-energy bullets-related injuries were included in the study. Data was statistically analyzed using SPSS-22 software.

Results:

Of all vascular injuries, 33(58%) were documented as venous and 24(42%) as arterial injuries. Overall, 65% of the injuries were extremity injuries and extremity vascular injuries were the most common: 24(42%) in the upper extremity, 23(40%) in the lower extremity (p > 0.36). Twenty-eight (60%) casualties with extremity vascular injuries had concomitant fractures on the same extremity.

Discussion:

Extremity vascular injuries predominate in our study. Upper extremity vascular injuries were also the most common (42%) followed by the lower extremity (40%) injuries. This is probably due to IEDs frequently located on the sloping land. As the study only involved treatment in the Role 2, data shows no vascular injury related mortality, limb loss or other morbidities.

Conclusion:

In combat situations, the decision to ligate or repair a venous injury was made according to the tactical situation, availability of the operating theatre, associated injuries and physiological status of the casualty. Larger vascular injury data with long term follow up should be analyzed to provide outcomes data and to establish better treatment and training strategies for military surgeons especially at Role 2 level.