Surgical strategy for combined wounds of vessels and internal organs

Surgical strategy and outcomes were analysed for 51 patients with combined wounds of internal organs and major blood vessels, with total 87 organ and 65 vessel injures. In 29 cases intracavity vessels were injured, in 22 - peripheral ones. In 47 cases (92.1%) traumas were gunshot. On admission 43 patients were in poor clinical condition with III-IV grade shock. The delay of surgical intervention did not exceed 30-40 min, all patients were operated in emergency, regardless of complete preoperative preparation. Blood reinfusion was used for all intracavity bleedings. The consequence of surgical steps was determined by localization of vascular trauma, bleeding intensity and severity of organ injuries. In order to decrease invasiveness and duration of surgery, conventional wound suturing was used for 53 organs, vascular plasty and sutures - in 35 cases, ligation of vessels - in 27. Lobectomy was executed in 1 case, intestinal resection and anastomosis - in 8, ileo-and colostomy - in 7 patients. Total 73 internal organs and 62 vessels were reconstructed. Postoperative complications have developed in 30 patients (58.8%), lethal outcome occurred in 3 patients during operation and in 10 (25.4%) - postoperatively. The majority of complications and deaths were observed for thoracoabdominal traumas. High postoperative mortality was also seen for patients with combined injuries of abdominal organs and vessels (13.7%).