Fork from camping utensils as a wounded shell caused severe vascular injury in a combat patient injured in the war in Ukraine: a case report

The war in Ukraine is associated with severe injuries and challenges in the management of patients. There are various kinds of high-energy ballistic projectiles, but kitchen cutlery or camping utensils parts, such as forks, knives, or spoons, are not usually expected to be found in the gunshot wound, but might serve as a ballistic projectile causing severe damage to the human body. Vascular injury is also a challenge in war surgery, and the application of temporary arterial shunts is a good approach, as well as the application of damage control tactics. The aim of this study was to demonstrate the rare case of management of the combat patient who received a severe vascular injury to the femoral artery by fork from camping utensils after the strike by the KAB precision-guided munition, who was treated with temporary arterial shunts with application of DCR and DCS. A 34-year-old Ukrainian soldier was wounded by a precision-guided munition (KAB) in East Ukraine. The injury resulted in severe trauma to the left lower extremity, including superficial femoral artery damage. Due to the persistent threat of drone attacks, the rapid evacuation to advanced medical facilities was delayed for 12 h. The Forward Surgical Team diagnosed the patient with arterial thrombosis of superficial femoral artery and a foreign metal mass, identified as a fork, which was a part of a camping utensil, embedded in the hip. Surgical intervention involved the removal of the foreign bodies and amputation below the upper third of the hip due to critical arterial ischemia. The patient was stabilized, transferred to a higher-level field hospital, and eventually discharged after 21 days for rehabilitation and prosthetic fitting. The trajectory of a high-energy ballistic projectile might go through the various objects (e.g., cutlery forks, etc.), followed by their involvement in the injury process, and increase the severity of the wounds. Ongoing war in Ukraine is associated with the impossibility of wide use of the aeromedical evacuation due to tactical obstacles, resulting in prolongation of the time for patients’ evacuation to higher level of medical care and higher risk for extremity amputations in patients with vascular injury.