Nabeel Y Almadwahi1, Hamza Z Al-Hodiafy2, Mohammed A Al-Shuja’a3, Saleh A Alammari4, Haitham M Jowah5,*
1Department of Vascular Surgery, Faculty of Medicine, Sana’a University, Sana’a City, Yemen
2Department of Vascular Surgery, 48 Model Hospital, Sana’a City, Yemen
3Department of Vascular Surgery, Faculty of Medicine, Sana’a University, Sana’a City, Yemen
4Department of Vascular Surgery, 48 Model Hospital, Sana’a City, Yemen
5Department of Surgery, Faculty of Medicine, Sana’a University, Sana’a City, Yemen
Correspondence to: Haitham M Jowah, Plastic Surgeon, Department of Surgery, Faculty of Medicine, Sana’a University, Sana’a City, Yemen
Received date: May 22, 2024; Accepted Date: June 4, 2024; Published Date: June 27, 2024
Citation: AlmadwahiNY,etal.(2024), Comprehensive Risk and Prognostic Analysis of Femoropopliteal Vascular Damage in Yemen Conflict : Limb Salvage and Mortality Rates. IJMRS @ PubScholars Group. 2024;1(5): pp: 28-38
Copyright: ©2024 Almadwahi NY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
ABSTRACT
Introduction: The objectives of this study were to ascertain the results of early care and to pinpoint the risk variables linked to death and limb loss in cases of penetrating femoropopliteal vascular damage sustained during Yemeni warfare.
Methods: From January 2020 to October 2023, a prospective study was carried out in the military referral center, 48 Model Hospital, located in Sana’a, Yemen. Patients with penetrating femoropopliteal vascular damage from trauma due to combat were the subject of this investigation. Excluded patients were those with primary traumatic amputation, acute trauma, and out-of-hospital treatment. During the preoperative phase and hospital stay, the study used a standardized questionnaire to gather information on patient demographics, damage patterns, surgical repair techniques, and early management outcomes.
Results: We analyzed 65 cases of wartime femoropopliteal injuries and found that high-velocity gunshot wounds were the main cause (47.7%). Most patients were young males, with a median age of 25. Associated soft tissue injuries were present in 92.3% of cases, with severe crush injuries in 46.7%. Arterial injuries occurred in 90.8% of patients, predominantly affecting the popliteal artery (57.6%), while venous injuries occurred in 73.8% of patients, mostly involving partial transection of the popliteal vein. Nerve injuries were observed in 13.8% of cases and bone injuries in 21.5%. The primary arterial repair methods were reverse saphenous interposition graft (n=35) and primary reconstruction (n=18), whereas venorrhaphy and saphenous interposition graft were the most common venous repair methods. Intraoperative complications were seen in 7.7% of cases, and postoperative complications in 35.4%, with wound infection being the most frequent. The median hospital stay was 17 days, and secondary amputations were required in 4.6% of cases. The mortality rate was 3.4%. Limb salvage was achieved in 62 patients, with the majority (80%) achieving functional independence in ambulation. Predictors of secondary amputation included intraoperative complications, associated bone fracture injury, systolic blood pressure, hemodynamic instability, intraoperative ankle stiffness, and pulse rate. Predictors of mortality included systolic blood pressure, hemodynamic instability, postoperative ischemia-reperfusion injury, venous ligation, multiorgan failure, sepsis, and septic shock.
Conclusion: It is difficult to penetrate femoropopliteal vascular damage in Yemen during hostilities. We stress the significance of shock, ankle rigidity, and IRI as critical risk factors for amputation and mortality, and we recommend for tailored treatment based on hemodynamic stability and muscle viability rather than ischemia duration alone.
