Lower limb revascularization in patients with tibial artery rupture and fibula fracture resulting from a shrapnel wound

Shrapnel wounds to soft tissues of the extremities predominate in the structure of combat trauma during the Special Military Operation. These injuries are often combined with bone fractures and rupture of the vascular-nerve bundles. Optimally selected treatment tactics at the early stages of medical care allow for a positive prognosis for the course of the pathology. The aim of the study. To demonstrate the results of surgical treatment of a serviceman with a shrapnel blind wound to the right shin, a gunshot comminuted fracture of the fibula, and rupture of the shin vessels at the military field hospital stage. Materials and Methods. A 47-year-old serviceman received a shrapnel blind wound to the right shin as a result of a shell explosion. He was evacuated to the military field hospital (level 2). On examination, signs of acute ischemia of the right lower extremity of stage 2b were revealed. Radiographic data revealed a comminuted fracture of the upper third of the right fibula. Ultrasound examination of the right leg vessels revealed a pulsating hematoma with a volume of 30 ml; rupture of the anterior tibial artery (by bone fragments), posterior tibial artery (by a metal fragment), and popliteal vein. Results. Due to the presence of a pulsating hematoma, severe pain, progression of acute ischemia symptoms, and the risk of external bleeding, a decision was made to perform surgical intervention: removal of the pulsating hematoma of the right leg, suturing of the popliteal vein wall defects, autogenous popliteal-posterior tibial grafting, and fasciotomy. The postoperative period was uneventful. The serviceman underwent rehabilitation and returned to military duties 3 months after the injury. Conclusion. Revascularization of the lower extremity at the stage of military field hospital with ruptured leg vessels as a result of a shrapnel wound made it possible to preserve the limb and return the serviceman to duty.

1. Kazantsev A. N., Vshivkov K. N., Popov A. A., Bushlanov P. S., Gaptrakipov I. Kh., Pavlenko N. A., Tenishev R. R., Kholmatov V. N. False aneurysm and arteriovenous fistula between the popliteal artery and popliteal vein one year after shrapnel wound: surgical reconstruction in a military field hospital of the special military operation zone. Sibirskiy zhurnal klinicheskoy i eksperimentalnoy meditsiny = Siberian Journal of Clinical and Experimental Medicine. 2025; 40 (4): 220–226. doi: 10.29001/2073-8552-2025-40-4-220-226 (In Russ.).

2. Trishkin D. V. Results of the activities of the medical service of the armed forces of the Russian Federation in 2024 and tasks for 2025. Voenno-meditsinskiy zhurnal = Military Medical Journal. 2025; 346 (1): 4–20 (In Russ.). doi: 10.52424/00269050_2024_346_1_4.

3. Gavrilov E. K., Ramazanov A. Yu., Goncharov A. V. Frequency and structure of combat-related gunshot vascular trauma in a forward-looking level-three medical organization in a modern armed conflict. Angiology and vascular surgery. Angiologiya i sosudistaya khirurgiya. Zhurnal im. akademika A. V. Pokrovskogo = Journal named after Academician A. V. Pokrovsky. 2024; 30 (2): 143–150. doi: 10.33029/1027-6661-2024-30-2-143-150 (In Russ.).

4. Tenishev R. R., Kazantsev A. N., Belyai Zh. M., Shishkin A. G., Koshil Yu. E., Yakimavichus R. P., Vasiliev D. S., Kholmatov V. N. Results of surgical treatment of patients with false peripheral artery aneurysms in a military field hospital of the special military operation zone. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2025; 30 (S10): 67–73. doi: 10.15829/1560-4071-2025-6477 (In Russ.).

5. Ivchenko E. V., Ovchinnikov D. V. Main scientific and practical results of the study of combat pathology during a special military operation at the Military Medical Academy. Vestnik Rossiyskoy voenno-meditsinskoy akademii = Bulletin of the Russian Military Medical Academy. 2024; 43 (4): 457–469. doi: 10.17816/rmmar636549 (In Russ.). 6. Perekhodov S. N., Onnitsev I. E., Kozlov N. S., Kuzminov A. D. Modern approach to gunshot wound treatment. Khirurg = Surgeon. 2025; 207 (5–6): 8–20. doi: 10.33920/med-15-2503-01 (In Russ.).

6. Kharchenko O. Yu., Kazantsev A. N., Alekseev O. V., Makhmudov R. M., Kholmatov V. N., Tenishev R. R. Removal of a false post-traumatic aneurysm of the axillary artery in a separate medical aeromobile unit of the special military operation zone. Khirurgiya. Zhurnal imeni N. I. Pirogova = Pirogov Russian Journal of Surgery. 2025; 6: 122–127. doi: 10.17116/hirurgia2025061122 (In Russ.).

7. Kraynyukov P. E., Shershnev S. P., Rybchinsky S. S. Ultrasound diagnostics in military personnel during a special military operation: current organizational and diagnostic aspects. Voenno-meditsinskiy zhurnal = Military Medical Journal. 2024; 345 (10): 50–57. doi: 10.52424/00269050_2024_345_10_50 (In Russ.).

8. Gavrilov E. K., Zokhrabov F. I., Khubulava G. G. Ultrasound angioscanning in early diagnostics of combat gunshot vascular trauma of the lower extremities. Flebologiya = Phlebology. 2023; 17 (4): 320–328. doi: 10.17116/flebo202317041320 (In Russ.).

9. Trukhan A. P., Strigo A. V., Doronin M. V. Modern requirements for the training of military surgeons. Voennaya meditsina = Military Medicine. 2025; 75 (2): 125–129. doi: 10.51922/2074-5044.2025.2.125 (In Russ.).

10. Kholmatov V. N., Kazantsev A. N., Bolibok N. V., Belyai Zh. M., Tenishev R. R., Gaptrakipov I. Kh. Surgical treatment of a mine blast injury with the formation of a false popliteal artery aneurysm in a military field hospital of the special military operation zone. Politravma = Polytrauma. 2025; (3): 44–50. doi: 10.24412/1819-1495-2025-3-44-50 (In Russ.).

11. Rozin Yu. A., Ivanenko A. A. Specialized surgical care in the treatment of combat vascular trauma. Vestnik neotlozhnoy i vosstanovitelnoy khirurgii = Bulletin of Emergency and Reconstructive Surgery. 2016; 1 (1): 32–36 (In Russ.).

12. Esipov A. V., Pinchuk O. V., Yamenskov V. V., Rakov A. A. Treatment of combat trauma of the great vessels of the upper extremities at the first stage of specialized care. Voenno-meditsinskiy zhurnal = Military Medical Journal. 2023; 344 (1): 38-45. (In Russ.). DOI: 10.52424/00269050_2023_344_1_38.

13. Yamenskov V. V., Ushakov S. A., Filippov A. V., Rakov A. A., Ivanov A. V. Modern possibilities for treating post-traumatic false aneurysms at the stage of specialized medical care. Meditsinskiy vestnik MVD = Medical Bulletin of the Ministry of Internal Affairs. 2024; 128 (1): 11–16. doi: 10.52341/20738080_2024_128_1_11 (In Russ.).