Арозивні кровотечі у поранених з ушкодженнями магістральних судин кінцівок

Combat-related extremity vascular injuries are among the most challenging in military surgery. These injuries are frequently associated with extensive soft-tissue loss and high levels of initial wound contaminations, which significantly increase the risk of erosion-related bleeding and limb loss. Erosion-related bleeding is one of the most dangerous complications following reconstructive procedures on major vessels; it directly affects limb preservation and patient survival, thus necessitating timely prevention and effective surgical control. The aim of the study was to determine the incidence, risk factors, and features of surgical treatment of erosive bleeding in wounded patients with injuries to major limb vessels, and to assess the role of vacuum therapy in the prevention and management of this complication. Materials and methods. A retrospective study was conducted on 85 military personnel with combat-related extremity vascular injuries treated at a Role IV military medical facility in Kyiv in 2022. Negative pressure wound therapy (NPWT) was applied in all cases as part of a comprehensive staged surgical treatment protocol. The variables analyzed included the incidence of erosion-related bleeding, its association with infectious complications, timing of hemorrhage onset, microbiological culture results, methods of surgical control, limb salvage, and mortality outcomes. Results. Erosion-related bleeding occurred in 9 patients (13 %) with recurrent episodes (up to three events) in three cases. The complication was most frequently associated with a localized wound infection (n = 4) and sepsis (n = 3). The median time to onset of erosion-related bleeding was 18 days (range 6–29 days). Primary wound contamination was present in 57 % of patients. During the first week, Gram-positive organisms predominated (74 %), while by the third week, Gram-negative pathogens became dominant, primarily Acinetobacter baumannii (53 %) and Pseudomonas aeruginosa (15 %). Hemorrhage control techniques included autogenous vein grafts (n = 4), allograft replacements (n = 2), vessel ligations (n = 2), and vessel wall repair (n = 1). A secondary amputation was required in one patient, and no deaths were recorded. NPWT was used both before and after bleeding episodes to optimize wound conditions and prepare for definitive soft-tissue coverage. Conclusions. Erosion-related bleeding remains a significant challenge in the management of combat-related extremity vascular injuries, especially in the presence of severe infection and sepsis. Key preventive measures include protecting vascular repairs from mechanical trauma and desiccation, early and appropriate use of NPWT, and timely definitive soft-tissue coverage.