[Vascular injuries in war]

This paper reviews military vascular injuries in Southern Croatia.

Report of surgical procedures in war-related arterial and venous injuries in association with soft tissue destruction and bone involvement, with its post-operative medical and physical therapy. For vascular surgeons cases are presented, which are seldomly seen in civilian circumstances. For this reason this paper is published.

A retrospective review was done for 189 wounded (13 females, 175 males) with vascular injuries in the time period from June 1991 through December 1993. Ninety-one (48.1%) of the patients sustained injuries due to explosive weapons (different types of mines, grenades and its fragments). Extensive soft-tissue and bone destruction was associated in 55 (36.2%) wounded. The age ranged from 14 to 63 (mean 27.3) years. The operative techniques involved the debridement of devitalised and infected tissue, prophylactic fasciotomy, the reconstruction of major venous injuries, application of microsurgical techniques in selected cases and the extensive use of autogenous interposition grafts. The wounds were treated by secondary closure and routinely antibiotics were given. In selected cases an arteriography was performed preoperatively. Vascular injury with a prolonged time of ischemia were the most common indication for hyperbaric oxygenation (HBO).

Six (3.2%) patients died from associated severe injuries. In sixteen (15.1%) cases a subsequent amputation had to be performed.

The results of this study support the reconstruction of major vessel damage in order to save a limb. Careful and regular follow-up examinations also by other medical specialties proved to enhance a positive outcome for this severely injured patients. We also suggest the extensive use of HBO in war casualties.