The problem of treating
injuries of large vessels in times of peace has been sufficiently well developed both in theoretical and practical aspects. In times of war, however, due to the large numbers of the wounded, a shortage of expert angiosurgeons, and multiple
gunshot wounds, many theoretical tenets lose their academic regularity. The present study is based on the experience of treating 302 patients wounded during the Afghanistan war (1981-1985). Most of the
injuries were to the vessels of the extremities. The
gunshot wounds were complex. They included extensive destruction of tissue in the damaged segments of the extremities with simultaneous damage of large veins (42.0% of the cases), nerves (45.5%), and bones (47.4%). Multiple-vessel
injuries were encountered in 4% of the cases, with combined
injuries comprising 17.5%. Most of the wounded (83.7%) were in a state of
shock, with 6.4% in a terminal condition. The blood loss amounted to 15% to 65% of the total volume. Ninety percent of the wounded were admitted to hospitals in the first 6 hours. A two-stage method was used to treat 71 of the wounded. The method included temporary bypass of the injured arteries and veins while evacuating the wounded and during surgery. Two hundred ninety-five wounded underwent vessel surgery. Out of the total number of
injuries of arteries and veins, vessel
sutures were used in 36.9% and 35.9% of the cases, vessel plastics in 41.4% and 7.1% of the cases, and vessel
ligation in 21.7% and 60.0% of the cases, respectively. Surgery was completed by fixing the bone fragments externally with the help of special devices using the
Ilizarov method.
Amputation was performed in 13.9% of the cases. In 7.3% of the cases
amputation was performed according to primary indications (no reconstructive surgery attempted on the vessels). In 6.6% of the cases extremities were amputated during the early postoperative period as a result of vessel
thrombosis and an increase of tissue
ischemia. The mortality rate after vessel surgery was 5.3%. We believe that for patients with
gunshot wounds involving vessel
injuries, early one-time reconstruction of the destroyed anatomical structures should be performed.