BMJ military health · 2026
NPWT in combat-related extremity vascular injuries: a case series and safety algorithm.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Sivash Iurii, Koval Boris
Аннотация
INTRODUCTION: Combat extremity vascular injuries are frequently associated with extensive soft-tissue loss and contamination, increasing the risk of infection, graft thrombosis and erosion-related bleeding (ERB). Negative pressure wound therapy (NPWT) is widely used to manage complex combat wounds, but evidence regarding its use after vascular reconstruction remains limited.
METHODS: We retrospectively analysed 69 patients with combat-related vascular injuries who underwent NPWT at a Role IV (Echelon of Care in the Military Medical System) facility in Ukraine during 2022. NPWT applications were categorised into two predefined groups: an interface group-NPWT applied adjacent to exposed vascular reconstructions using a protective multilayer system (n=28); and a covered group-NPWT applied over established soft-tissue or muscle flap coverage (n=41). Outcomes included ERB, graft thrombosis, infectious complications and limb loss. NPWT was applied as part of staged wound management following debridement and revascularisation.
RESULTS: ERB occurred exclusively in the interface group (9/28, 32.1%) and was not observed in the covered group (0/41). ERB events were observed only prior to stable soft-tissue or flap coverage. Graft thrombosis (14.3% vs 4.9%), wound infection (10.7% vs 2.4%) and secondary amputations (7.1% vs 0%) were more frequent in the interface group. Overall limb salvage was 97.1%. Two ERB risk windows were observed: postoperative days 7-10 (mechanical) and 18-30 (infection-related).
CONCLUSIONS: NPWT may be incorporated into staged wound management following combat-related extremity vascular reconstruction; however, outcomes differed according to the soft-tissue coverage strategy employed. Application of NPWT near exposed vascular repairs was associated with a higher ERB rate and should be considered a short-term temporising strategy when immediate definitive coverage is not feasible, and only within a controlled Role IV environment. Early definitive soft-tissue or muscle coverage remains the preferred protective strategy whenever feasible.
METHODS: We retrospectively analysed 69 patients with combat-related vascular injuries who underwent NPWT at a Role IV (Echelon of Care in the Military Medical System) facility in Ukraine during 2022. NPWT applications were categorised into two predefined groups: an interface group-NPWT applied adjacent to exposed vascular reconstructions using a protective multilayer system (n=28); and a covered group-NPWT applied over established soft-tissue or muscle flap coverage (n=41). Outcomes included ERB, graft thrombosis, infectious complications and limb loss. NPWT was applied as part of staged wound management following debridement and revascularisation.
RESULTS: ERB occurred exclusively in the interface group (9/28, 32.1%) and was not observed in the covered group (0/41). ERB events were observed only prior to stable soft-tissue or flap coverage. Graft thrombosis (14.3% vs 4.9%), wound infection (10.7% vs 2.4%) and secondary amputations (7.1% vs 0%) were more frequent in the interface group. Overall limb salvage was 97.1%. Two ERB risk windows were observed: postoperative days 7-10 (mechanical) and 18-30 (infection-related).
CONCLUSIONS: NPWT may be incorporated into staged wound management following combat-related extremity vascular reconstruction; however, outcomes differed according to the soft-tissue coverage strategy employed. Application of NPWT near exposed vascular repairs was associated with a higher ERB rate and should be considered a short-term temporising strategy when immediate definitive coverage is not feasible, and only within a controlled Role IV environment. Early definitive soft-tissue or muscle coverage remains the preferred protective strategy whenever feasible.