Background: This study presents the management of patients with war-related injuries and early results of vascular injuries treated at a secondary care hospital neighboring to civil war. Methods: Between December 2013-December 2014 ninety-six war-related injury patients evaluated by a single vascular surgeon and participating disciplines according to components of injury in polytrauma patients. Thirty-six patients who underwent vascular surgery were retrospectively registered to the study. Demographics, treatment and early results of patients reviewed. Results: Mean age was 26.69±11.80 (7-66) years and 91.66% (33/36) were males. Injuries were caused by shrapnel wound due to bombing 61.11% (22/36), stab wound 8.33% (3/36), gunshot wound 30.55 % (11/36). The number of patients with polytrauma was 29, seven patients had isolated vascular injury. Among 42 arterial and 31 venous injuries primary suture repair, autologous vein graft interposition and prosthetic graft interposition performed to 20.54% (15), 28.76% (21), 19.17% (14) respectively. Amputation and all-cause mortality were %8.3 (3/36), 13.8% (5/36) respectively. Conclusions: Vascular injury with concomitant trauma is the main issue of war-related injuries. Surgeons should be cautious about patients who were initially deemed not to need surgery for vascular injury and then were found to need it. Repetitive physical examination is very important in case of any suspicion, especially in limited conditions for diagnostic tools like CT angiography. A rapid, careful multidisciplinary evaluation of experienced surgeons for the diagnosis and the treatment priorities in war-related injury patients may lead to increase life and limb salvage rates with a better quality of life.
The applications of negative-pressure wound therapy (NPWT) have achieved remarkable diversification. Initially used in the therapy of soft tissue wounds related to open fractures, this technique led to the understanding of the complex mechanisms underlying it. This paper aims to analyze the evolutionary scenarios of a group of patients with heterogeneous lesions under negative pressure aspiration treatment. We aimed to identify and analyze various associated pathologies that have the potential to negatively influence the healing process under negative pressure treatment and implicitly analyze the particularities of representative cases for the group whose evolution under treatment proved to be unfavorable. Retrospective, observational study, type series of cases focused on a group of 17 hospitalized patients, who received treatment by negative aspiration, between 2015-2019 in the Surgery Department of the University Emergency Hospital Bucharest. Regarding the obtained results, diabetes mellitus, obliterating arteriopathy, and anemia had a prevalent distribution in the group with unfavorable evolution. The glycemic value can predict 17% of the evolutionary scenario of a patient (favorable/unfavorable) being necessary an integrative therapeutic conduct. Concluding, although an extremely promising therapeutic option, NPWT can prove to be disappointing given its impact in the background of suboptimally managed comorbidities.