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Year 2018 Vol. 26 No 3

MILITARY FIELD SURGERY

IE.V. TSEMA 1, 2, A.A. BESPALENKO 1, 3, A.V. DINETS 1, B.M. KOVAL 1, V.G. MISHALOV 1

STUDY OF DAMAGING FACTORS OF CONTEMPORARY WAR, LEADING TO THE LIMB LOSS

A.A. Bogomolets National Medical University 1, Kiev
National Military Medical Clinical Center of Ministry of Defense of Ukraine 2, Kiev,
Military Medical Clinical Center for Occupational Pathology of Personnel of the Ministry of Defense of Ukraine 3, Irpin,
Ukraine

Objective. To study the main damaging factors and causes of limb amputations in the contemporary war conflict.
Methods. 191 cases of limb amputations in 159 injured persons from 01.06.2014 to 30.06.2016 have been analyzed. The mean age of patients at the moment of getting a wound was 33±8.9 years (M±σ) (ranging from 18 to 60). There were 158 (99.4%) males and 1 (0.6%) female. The mean term of military service at the moment of injury was 2.0±3.7 years (M±σ) (ranging from 11 days to 25 years).
Results. One limb amputation was performed in 130 (81.8%) injured persons, two limbs – in 27 (17.0%), three/four limbs – in 2 (1.3%) patients. 62 upper limb amputations were carried out: 18 (29.0%) – of the arm, 25 (40.3%) – of the forearm, 19 (30.7%) – of the hand. 129 lower limb amputations were performed: 55 (42.6%) – of thigh, 53 (41.1%) – of the leg, 21 (16.3%) – of the foot. In 140 (73.3%) cases, the reason for the limb amputation was mine-explosive injury which in 93 (66.4%) cases caused traumatic limb avulsion. In 16 (8.4%) cases, multiple shrapnel wounds were the main cause of the limb loss; 15 (7.9%) – frostbit injuries; 11 (5.8%) – bullet gunshot wounds; 4 (2,1%) – explosive behind-armor injuries; 3 (1.6%) cases – train accident with traumatic limb avulsion; 2 (1.0%) – concrete constructions collapse.
Conclusions. In the modern war conflict, limb amputation is determined by both combat (90.6%) and non-combat damaging factors (9.4%). The causes of limb amputations in 69.1% cases were associated with simultaneous occurrence of severe irreversible changes which were inevitable; potential opportunity to prevent limb amputation (or change amputation level) was in 28.8% cases.

Keywords: war-related injuries, armed conflicts and wars, limbs, amputation
p. 321-331 of the original issue
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Address for correspondence:
01601, Ukraine,
Kiev, Shevchenko Boul., 13,
A.A. Bogomolets National Medical University,
Department of Surgery № 4,
tel.: +38 063 731-59-95,
e-mail: hemorrhoid@ukr.net,
Ievgen V. Tsema
Information about the authors:
Tsema Ievgen V., MD, Associate Professor, Associate Professor of the Department of Surgery №4, A.A. Bogomolets National Medical University, Surgeon of the Abdominal Surgery Department, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Kiev, Ukraine.
http://orcid.org/0000-0002-1178-7529
Bespalenko Artem A., Post-graduate Student, the Department of Orthopedics and Traumatology, A.A. Bogomolets National Medical University, Head of the Traumatology Department, Military Medical Clinical Center for Occupational Pathology of Personnel of Ministry of Defense of Ukraine, Irpin, Ukraine
http://orcid.org/0000-0003-2498-4334
Dinets Andrii V., PhD, Associate Professor of the Department of Surgery №4, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0001-9680-7519
Koval Boris M., PhD, Associate Professor of the Department of Surgery №4, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0003-0166-8603
Mishalov Vladimir G., MD, Professor, Head of the Department of Surgery №4, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0001-7263-7375
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