Substantiation of indications for limb amputation in civilian victims with multisystem injuries as a result of modern warfare

Objective. To define standardized criteria for the need for limb amputation in civilian victims with multisystem injuries as a result of modern warfare Materials and methods. The total study population of 2122 victims with injuries as a result of current hostilities in eastern Ukraine after the full–scale invasion of Russian troops into our territory from February 2022 to November 2024 was studied and analyzed, of whom 1069 (50.38%) had limb injuries. The study population was formed by irreversible randomization based on the combination of the victim's civilian status and limb injury as a component of a polysystemic injury. Results. An original standardized assessment system based on an organic combination of assessment of signs of direct limb damage and signs of general damage was developed. This allows for an objective assessment of limb injury as a component of multisystem damage. It is especially important that this approach makes it possible to determine the safety of preserving the limb for the victim's life. It was found that the question of the need for limb amputation arises in victims with a general condition score of more than 20 points on the original standardized scale, and it depends on the clinical and anatomical signs of injury. Thus, the highest risk of amputation – 62% – is for forearm injuries in victims with a general condition score of more than 30 points, and for injuries to the lower leg and foot, i.e. the distal parts of the lower limb, this figure is 41.18 and 42.86%, respectively. It was also found that in victims whose condition was assessed as extremely severe, the incidence of lower limb injuries was 64.46%, in particular, 16.82% of the thigh and 30.84% of the lower leg. In general, injuries to the lower extremities are considered to be the most severe Conclusions. Formation of indications for amputation of limbs in civilian victims with polysystemic injuries as a result of modern combat operations requires a standardized approach based on objective evaluation criteria. Not only the condition of the limb should be assessed, but also the general condition of the victim, as combat trauma to the limbs is polystructural and polysystemic. When interpreting the assessment of the need for limb amputation, the priority should be given to the principle of preserving the life of the victim, not the damaged limb, so the use of combined standardized assessment systems is justified.