Femoral artery reconstruction for irreversible foot ischemia 14 days after shrapnel injury

This article examines the complex clinical challenges of military field surgery based on experiences from the Special Military Operation. It focuses on combat-related limb injuries, predominantly from mine-blast and fragmentation mechanisms, characterized by extensive tissue destruction, a high incidence of major vascular injury, and risks of delayed complications (thrombosis, pseudoaneurysms). Using a detailed case study of a serviceman with delayed evacuation (14 days) after a shrapnel wound to the thigh, which led to rupture and thrombosis of the superficial femoral artery (SFA) and irreversible foot ischemia, the authors illustrate contemporary diagnostic and treatment approaches.

The article emphasizes that in delayed-presentation scenarios, comprehensive diagnostics using ultrasound angioscanning and standardized triage scales (e.g., Military Field Surgery – Injury, MFS-I; Military Field Surgery – Condition on Admission, MFS-CA) are critical. The presented surgical strategy-combining amputation of the nonviable distal segment (lower leg) with simultaneous autogenous vein reconstruction (reversed great saphenous vein graft) of the proximal artery–reflects a modern, pathophysiology-based approach. The authors conclude that treatment method selection (open vs. endovascular) must be individualized based on diagnostic findings, time since injury, and local tissue conditions. They highlight that successful outcomes rely on coordinated multidisciplinary teamwork within the staged treatment system, and such experiences are shaping a new paradigm for Russian military field surgery.

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