SURGICAL TACTICS IN CONCOMITANT OSTEOVASCULAR GUNSHOT WOUNDS

A.D. Gaibov, D.U. Urunbayev. F.A. Dadadzhanova
Chair of Hospital Surgery and Traumatology, Orthopedics and Field Surgery, Aboali Ibn Sino Tadjik State Medical University,
Dushanbe, Republic of Tadjikistan

The research is based on an analysis gained in the treatment of 46 victims with concomitant gunshot wounds of 58 bones and 56 vessels, operated on during the civil war in Tadjikistan (1992-1997). In 39 (84.8%) cases, injuries were inflicted by high-velocity ballets from automatic guns. Of the 58 bone injuries, wounds of the lower limbs accounted for 41 (70.7%) and those of the upper limbs for 17 (29.3%). The predominant' areas of injury were femoral (23 cases or 50%) and brachial (12 cases or 26.1%) bones. Eleven patients underwent Doppler ultrasound. Contrast angiography was performed in 6 cases. In 20 cases (43.4%) with comminuted fractures of tubular bones, extra-focal osteosynthesis was performed in accordance with initial indications, using compression and distraction appliances. Seventeen patients were treated by application of plaster bandages; eleven patients underwent skeletal traction. It is thought that primary fixation of bone fragments followed by blood flow restoration may be effective in these cases. Vascular suture was applied in ten cases with venous injuries caused by bone fragments. Vein graft was accomplished in fourteen patients having vascular injuries with defects larger than 4 cm. The least risk of arrosive bleeding was noticed in three patients having major injuries to soft tissues, with comminuted bone fractures in the area of the thigh. They underwent primary bypass in combination with extra-focal osteosynthesis. Ligation of arteries (6 cases) and veins (8 cases) was carried out, provided injuries were located in functionally insignificant zones. The two-stage surgical treatment of injuries is regarded to be of importance for prevention of wound infection. In the early postoperative period, twelve patients developed complications such as wound suppuration (8 cases) including arrosive bleeding (2 cases), and arterial thrombosis (4 cases). Three patients were subjected to limb amputation and 2 patients died from fat embolism and sepsis.

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