Surgical Treatment of Gunshot Damage to Deep Veins in Modern Armed Conflict
E.K. Gavrilov, F.I. Zokhrabov, E.A. Zangiev, Г. Г. Хубулава
Abstract
Objective. To study the features of gunshot wounds of lower limb veins accompanied by profuse venous bleeding in modern armed conflict; to evaluate the immediate postoperative results in these patients. Material and methods. We retrospectively analyzed the outcomes in 34 wounded with gunshot damage to lower limb veins. All patients were men. Mean age was 33.6±9.3 years. In most cases (n=28), profuse venous bleeding followed concomitant lesion of arteries and veins. Six wounded with profuse venous bleeding had damage to the deep veins alone. Surgical treatment was performed in all patients. We developed original method for stopping profuse bleeding, i.e. application of so-called “venous” tourniquet on lower limb segment several centimeters distal to gunshot wound. Results. Severity of injuries corresponded to 5.9±1.7 points (original scale for gunshot wounds developed at the Kirov Military Medical Academy). Compensated ischemia of lower limb was present in 5 cases, uncompensated — in 23 wounded (all ones with combined injuries of arteries and veins). Lesions of popliteal vein (16 cases), superficial femoral vein (n=8) and venous sinuses of legs (n=8). Nine patients had damage to several veins (most often superficial femoral and popliteal veins). Suturing of deep vein defect was performed in only 6 cases, ligation and transection — in other 28 cases. Arterial revascularization was performed in 28 patients (suturing in 15 cases, replacement by autologous vein in 13 cases). Wide fasciotomy was performed in 28 wounded. Mortality rate was 9.5% (2 cases). Thirty-day postoperative outcomes were followed-up in 21 (62%) patients. Revascularization was followed by lower limb amputations in 3 (14.3%) cases and repeated revascularization in 2 (9.5%) cases. The most common complication was unilateral deep vein thrombosis and clinically insignificant pulmonary embolism in some patients. Conclusion. The features of vein damage following gunshot wounds are frequent combination with damage to the arteries, shock in most victims and frequent damage to several veins. The simplest arterial revascularization of lower extremities and vein repair with stopping of profuse venous bleeding are advisable.