Authors: Nabeel Almadwahi, Ali Ahmed Barat, Abdulhafeedh Al-Habeet, Mohamed Alshujaa, Mohammed Saleh Najran, Sallam Al-Alhanash, Basim Almaqtari.
Context and Aim: In cases of severe lower extremity arterial injuries (LEAI), such as those resulting from combatrelated injuries, the preservation of the affected limb is a significant challenge. The combination of a temporary vascular shunt (TVS) and prophylactic fasciotomy (PF) has emerged as a potential approach to improving limb salvage outcomes in these cases. In the context of the war in Yemen, we aimed to assess the effect of combination TVS and PF on limb salvage after LEAI in patients with war-related polytrauma (WRPT).
Patients and Methods: A retrospective study was conducted among patients with WRPT at Al Hazm Hospital in Al Jawf Governorate in northeastern Yemen. Cases identified as polytrauma with LEAI in which PF was used comprise the study. These cases were matched to patients, or a control group, injured during the same period having polytrauma with LEAI requiring major vascular intervention but managed without fasciotomy. The primary outcome was surgical amputation.
Results: Inclusion criteria were met in 39 cases, 18 (46.2%) had undergone fasciotomy, while the other 21 (53.8%) did not. Both study groups were entirely young (mean age 26.32 ± 5.01 years) males (100%). The overall amputation rate was 17.9% (7 of 39 cases), with 6 (28.57%) cases in the non-fasciotomy group and 1 (5.55%) case in the fasciotomy group. The difference in amputation rate was not statistically significant (p-value, 0.071). Likewise, the mechanism of injury, clinical findings on admission, arterial injuries, and types of surgical procedures were similar in both groups. By contrast, the fasciotomy group had a lower rate of limb infection than their non-fasciotomy counterpart (38.1% vs. 5.6%, respectively). The mortality rate in the hospital was 5.1% (2 of 39 cases), and all of them did not undergo fasciotomies.
Conclusion: The combination of TVS and PF was associated with significantly improved limb infection. While statistically unproven, this combination may also enhance limb salvage. Therefore, it should be performed in cases of WRPT.
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