Femoral artery injuries due to gunshot injury in Somalia civilwar continues

Abstract

Objective: Surgical interventions and results of femoral arterial injuries due to gunshot injuries were evaluated and presented in Somalia, where civil war continued. Patients and Material and Methods: 18 patients who were operated due to femoral artery injury between November 2015-May 2016 were evaluated retrospectively.14 of the patients were male (77.7%). All patients were evaluated respectively for the age, gender, hospital admission time, femoral artery injury locations, revascularization techniques and graft selection, accompanying injuries, additional surgery procedures, infection rates, amputation and mortality. Results: The mean age was 27,83±8,39 (16-52). Additional injuries were as; 14 patients (77.8%) had venous injury, 8 patients (44.4%) had venous injury and nerve damage, 6 patients had bone fracture (33.3%), 2 patients (11.1%) intraabdominal injury and 3 patients (16.6%) had extensive soft tissue defects. The admission time to the hospital was quite delayed and the mean appealing time was 69.55±44.81 (6-144) hours. For revascularization; primary repair was performed in 1 patient (5.5%), end to end vascular repair in 3 patients (16.6%), saphenous vein graft in 10 patients (55.6%) and PTFE graft in 4 patients (22.2%). Fasciotomy was performed in 6 patients (33.3%) who were suspected or had compartment syndrome and amputation was performed in 2 patients (11,1%). Mortality causes were intrabdominal injury and hypotensive shock in one patient and sepsis in two patients. Mortality rate was 16.6%. The mean discharge interval was 12.9±5.11 (6-24) days. Conclusion: Surgical success and mortality of vascular injuries in the war zone is related with the duration of intervention, accompanying injuries, infection and motor loss. Particularly for the infection suspected cases, the usage of saphenous vein grafting is recommended and if the hemodynamic instability is present, bypassing by the PTFE graft may be a useful alternative to shorten the surgical time.