Saving the Limb-Tissue Collectors, Growth Factors, and Antibiotics in a War Injury

As a life-saving procedure, limb amputation is frequently indicated in severe war injuries, especially in suboptimal medical supply. We report of a 56-year-old Ukrainian male who was wounded on the battlefield by an air attack during Russian early invasion in Zaporizhzhia. The blast injury caused a critical soft-tissue defect of the lower leg combined with comminuted fractures of the tibia and fibula. Although indicated, the patient refused the amputation of the lower leg. Initially closed reduction and stabilization by an external fixator, local debridement as well as soft-tissue coverage by a porcine skin were performed at a local field hospital. Due to destroyed infrastructure and missing escape corridors, further evacuation was difficult. Thus, it took 15 days to transfer the patient by ground transportation to our institution. Based on the massive tissue loss, superinfection necrosis and questionable blood supply, the indication for amputation was confirmed, but the patient insisted on limb preservation. To save the lower leg, a brought spectrum of regenerative strategies was applied, accompanied by standard trauma treatment regimens (debridement, vacuum sealing, antibiotics, intramedullary nailing, suralis flap).

These included the local application of growth factors, the use of innovative tissue collectors, the implementation of biomaterial/tissue combinations and the application of a vasodilator. Six months after treatment, the patient was free of pain and infection. However, further follow-up was complicated by delayed bone healing and required revision surgery. Although the limb was saved, it ultimately took 1 year until full rehabilitation was achieved. This case illustrates the special demands in war lower leg injuries but also demonstrates that a combination of standardized and innovative treatment protocols can save a limb, even when amputation might be indicated as a first-line therapy.