Multiple bullet wounds with ruptured brachial artery, brachial vein, and comminimated fracture of the femorum. Surgical treatment in a field hospital in a special military operation zone

Background. Gunshot wounds are often accompanied by ruptured major vessels and bone fractures. In situations where both lesions occur, combined surgery is necessary. The prognosis of a service member’s survival depends on the optimal treatment strategy at the military field hospital (MFH). Objective. To demonstrate the results of surgical treatment of a soldier wounded in a MFH (level 2) with multiple gunshot wounds, accompanied by a rupture of the brachial artery, brachial vein, and a comminuted femur fracture. Results. A 28-year-old serviceman. During a firefight, he sustained penetrating and grazing bullet wounds to the chest, upper and lower extremities. He was evacuated to the MHF within an hour. A tourniquet was placed on the left shoulder due to bleeding from the wounds. On examination, acute stage 2B ischemia of the left upper extremity and signs of a left femur fracture were noted. Radiography revealed a comminuted fracture of the left femur diaphysis. Ultrasound of the left upper extremity vessels revealed a rupture of the brachial artery and brachial vein. Due to the presence of a tourniquet on the left shoulder, the risk of bleeding, and the development of irreversible limb ischemia, a decision was made to perform surgical intervention at the MHF stage (level 2). The defect in the brachial vein wall was sutured with a primary suture using 6/0 polypropylene thread. Then, autogenous vein grafting of the brachial artery with a reversed great saphenous vein was performed using 8/0 polypropylene thread. Simultaneously, a military field rod set was installed on the left thigh. An hour after the surgery, the symptoms of left upper limb ischemia completely regressed. The soldier was evacuated in stable condition for subsequent treatment. Conclusion. Combined reconstructive surgery of the shoulder vessels and installation of a military field rod set on the femur can be successfully performed at the stage of MHF to stabilize the wounded soldier’s condition.