Temporary prosthetics of the main vessels of the limbs: current experience and further prospects for use at the advanced stages of medical evacuation

Abstract

BACKGROUND: The study is devoted to the damage to the great vessels of the limbs and the surgery of temporary prosthetics of the main arteries during the advanced stages of a medical evacuation. A retrospective analysis of the database containing information from the register of combat injuries of the first and second Chechen campaigns was carried out, from which cases of temporary prosthetics of arteries performed in advanced medical institutions were analyzed.

AIM: The analysis of the cases of temporary artery prosthetics that have been carried out at the advanced medical institutions as well as the improvement of the technique of temporary prosthetic operations with respect to the use of the tool designed and developed by the authors- a three-branch mechanical deep vasodilator.

MATERIALS AND METHODS: A total of 14 wounded who underwent the temporary prosthetics operation were analyzed. The main indication for the patients to undergo surgery was uncompensated ischemia according to the classification of V.A. Kornilov, however, based on the data of the register, the operation was also performed on 5 wounded with compensated ischemia and 3 wounded with irreversible ischemia. At the same time, secondary amputations were performed on only 2 of the 14 wounded. Among the wounded with temporary prosthetics, not a single fatal outcome was detected, despite the presence of a terminal condition in one wounded person (more than 45 points on the “MFS-VD” scale (military-field surgery – vascular damage)). On average, for both Chechen campaigns, the average duration of the functioning of the temporary prosthetics was 8.1 ± 3.4 hours, provided that the role of the temporary prosthesis was mainly performed by their polyvinyl chloride tubes, and the prevention of thrombosis was carried out by local intraoperative administration of a heparin solution. To optimize the temporary prosthetics, the authors designed and manufactured (with the participation of MIZ-Vorsma) a special tool — a three-branch vasodilator, which facilitates the operation. The effectiveness of a three-branch vasodilator was studied on three anesthetized large biological objects (pigs weighing 45–51 kg) during the operation of the femoral arteries temporary prosthetics (diameter of the vessels from 3.9 to 4.3 mm) with a linear installation polyvinyl chloride prosthetics with a length of 3 cm and an outer diameter of 5 mm (a system from drip injection of infusion solutions). In the contralateral limb, temporary prosthetics was introduced without the use of a three-branch vasodilator. The ends of the prosthesis were fixed with ligatures to the artery wall. The time of manipulation without taking access to the artery into account with one assistant for temporary prosthetics was 41.1 (39.3–43.4) seconds, without temporary prosthetics — 59.3 (56.8–59.9) seconds. Manipulations with temporary prosthetics without the use of three-branch vasodilator were twice complicated by episodes of vaso slippage from the wall of the prosthesis, which led to massive bleeding. Such cases were not noted when using the expander.

RESULTS: As a result, the analysis of cases of temporary prosthetics of the main arteries of the limbs demonstrated the high effectiveness of the intervention aimed at stopping bleeding and maintaining temporary perfusion of the limb. Secondary amputations were performed on 14% of the wounded (2/14), no fatal cases have been reported. The tool developed to facilitate temporary prosthetics surgery can shorten the term of intervention, reduce intraoperative blood loss, limit the number of assistants and can be recommended for practical use in the advanced stages of evacuation.

Keywords

limb ischemia / three-branch mechanical deep vasodilator / secondary amputation / temporary prosthetics / vascular damage / vasodilator / wound

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RIGHTS & PERMISSIONS

Ibragimov R.I., Reva V.A.