DOI: https://doi.org/10.22141/1608-1706.4.20.2019.178754

Mistakes and complications of diagnosis and treatment of local hypertensive ischemic syndrome with gunshot injuries to the lower extremities

S.S. Strafun, A.M. Laksha, V.G. Shypunov, N.O. Borzyh, I.O. Lozhkin

Abstract


Background. Modern military conflicts are characterized by an increase in the proportion of polystructural damage to the extremities compared to other anatomical sites. Thus, according to the analysis of the structure of wounds during the Anti-Terrorist Operation, the number of injuries to the limbs reaches 64 %, while of trunk injuries — 20 %. Compartment syndrome, or local hypertensive ischemic syndrome (LHIS), is one of the most severe pathological conditions that underlies most complications of gunshot wounds to the extremities and can lead to persistent disability. The objective is to study mistakes in the diagnosis and treatment of LHIS against gunshot injuries of the lower extremities in order to prevent the development of complications. Materials and methods. We analyzed treatment outcomes in 58 patients with LHIS on the background of gunshot wounds and fractures of the bones of the lower extremities during the Anti-Terrorist Operation in the Eastern Ukraine. All patients were males aged 21 to 62 years, with a mean age of 45.8 ± 3.3 years. According to the nature of the damaging factor, in 34 (60.5 %) cases LHIS developed against the background of gunshot fractures of long tubular bones, in 15 (26.5 %) — after a mine blast injury with limb fractures and in 9 (13 %) cases — following multiple fragment wounds to the soft tissues of the lower extremities. Depending on the localization of LHIS, following lesions predominated: of the shin — 31 (55 %), hips — 23 (39 %), buttocks — 2 (3.4 %), feet — 2 (3.4 %). Results. The development and progression of LHIS in gunshot injuries to the lower extremities with a high degree of certainty is associated with neglect of the etiopathogenetic mechanism of complication development and impaired performance of fasciotomy of the affected segment. Conclusions. Analysis of treatment outcomes in patients with LHIS at gunshot injuries to the lower extremities allowed us to identify a group of strategic and tactical mistakes that statistically significantly influenced the development of compartment syndrome. The identified group of strategic mistakes related to the neglect of the etiopathogenetic mechanisms of LHIS development significantly influenced the development of non-reversible ischemic changes in LHIS in 22 (37.9 %) cases (p < 0.05). The identified group of tactical mistakes related to violation of the fasciotomy technique led to the development of non-reversible changes in the muscles of the affected segment in LHIS in 28 (48 %) cases (p < 0.01). The data obtained indicate the need to continue research on this issue, to popularize information about the risk of developing compartment syndrome in inflammatory injuries of the extremities, the technique of fasciotomies, etc.

Keywords


compartment syndrome; local hypertensive ischemic syndrome; gunshot injuries

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