Keywords
combat surgical trauma
amputation
quality of life
EQ-5D
medical rehabilitation
How to Cite
Abstract
In press
Background. Optimization of combat surgical trauma management, particularly timely amputation and subsequent prosthetics, is a relevant task of wartime medicine.
Aim. To analyze the full cycle of treatment and rehabilitation of a patient with severe combined blast injury of both lower limbs using a clinical case example, focusing on a multidisciplinary approach and quality of life assessment.
Materials and Methods. A clinical case of treatment of a 42-year-old serviceman with open comminuted fractures of both lower leg bones and feet, as well as blast injury to the chest and abdomen, is presented. Clinical examination data, radiological studies, and dynamic observation were used. The patient's condition was assessed using the Glasgow Coma Scale. Treatment effectiveness and quality of life were evaluated using the Ukrainian version of the standardized EuroQol EQ-5D-5L questionnaire. The study did not receive targeted support in the form of grants from public or private foundations, it was carried out as a private initiative of the authors.
Research Ethics. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki (1964–2024). The patient provided informed voluntary consent for the use of his anonymized medical data for scientific analysis and publication. The research algorithm and methods were approved by the local ethics commission.
Results. The initial treatment strategy included intensive therapy, antibiotic prophylaxis, primary surgical debridement, VAC (Vacuum-Assisted Closure) therapy, and osteosynthesis with external fixation devices. On day 18, a purulent complication (S. aureus) developed, with a predicted unfavorable outcome for preserving the right limb. After discussion with the patient, amputation of the right lower leg was performed. Rehabilitation at a specialized center included physiotherapy, therapeutic exercises, orthotic support for the left limb, and prosthetic fitting for the right. Assessment with the EQ-5D-5L on day 134 showed significant limitations (profile 21212, index 8), while after 12 months, significant improvement was recorded (profile 11110, index 4).
Conclusions. This clinical case demonstrates that the success in managing severe blast injuries is based on a multidisciplinary approach, timely application of modern surgical technologies (VAC therapy, external fixation), timely and justified decision-making for amputation when the prognosis is unfavorable, and subsequent comprehensive rehabilitation with prosthetics. This algorithm allows not only saving the patient's life but also ensuring a high level of functional recovery and quality of life.
Keywords: orthopedics and traumatology, combat surgical trauma, amputation, quality of life, EQ-5D, medical rehabilitation.
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