Blind fragment injury of a branch of the deep femoral artery with delayed hemorrhage: A clinical case

Introduction. In some cases, fragment wounds are accompanied by damage to major arteries. The choice of a treatment strategy at the stage of military-field hospital сare determines the life prognosis of the serviceman.

Case description. A case of successful surgical treatment of a serviceman in a military field hospital is presented. The case involved a blind fragment wound to the thigh with avulsion of a branch of the deep femoral artery, which manifested 24 h after the initial surgical debridement of the wound and removal of a metallic shell fragment. An open surgery with ligation of the branch of the deep femoral artery with removal of the pulsatile hematoma was performed. The postoperative period proceeded without complications.

Conclusions. Convincing data on the necessity of conducting ultrasound examination of blood vessels in cases of fragment wounds in all instances, even in the absence of signs of hemorrhage, were obtained. In the case of a ruptured branch of the deep femoral artery, its ligation under the conditions of a military field hospital is an effective and safe method of surgical correction.

1. Gumerova EA, Dubrovskikh SN, Tatarina AV, Stepanova YuA, Avilova EP. Effectiveness of ultrasonic diagnostics in a comprehensive approach to the care of patients with peripheral nerve injuryin gunshot trauma of the extremities: a case study. Hospital Medicine: Science and Practice. 2025;8(3):48–52 (In Russ.). EDN: CWPIAS

2. Vasilchenko MV, Volchkov VA, Bunin SA, Rychkov VL, Rumyantsev AV, Volchkov GV. Analysis of the structure of combat injuries sustained during special military operation (based on the experience of providing qualified and specialized surgical care in a multidisciplinary hospital). Emergency Surgery Named after I.I. Dzhanelidze. 2025;18(1):16–22 (In Russ.). EDN: UWELQM

3. Trishkin DV, Kryukov EV, Davydov DV, Khominets VV, Brizhany LK, Konokotin DA. Development of the concept of providing medical care to wounded with injuries to the musculoskeletal in modern conditions. Military Medical Journal. 2024;345(5):4–11 (In Russ.). EDN: TALTJH

4. Tenishev RR, Kazantsev AN, Belyai ZhM, Shishkin AG, Koshil YuE, Yakimavichus RP, et al. Surgical treatment of patients with peripheral artery pseudoaneurysm in a field hospital within Special Military Operation. Russian Journal of Cardiology. 2025;30(S10):67–73 (In Russ.). https://doi.org/10.15829/15604071-2025-6477

5. Steklov VI, Krasnikov MP, Gorin DYu, Morozova NV. Dissociation of posttraumatic arteriovenous fistula on the leg. The Journal Named after N.I. Pirogov. 2025;9:128–33 (In Russ.). https://doi.org/10.17116/hirurgia2025091128

6. Usmonov UD. Modern issues in the organization of surgical care for non-gunshot soft tissue injuries in military personnel within the system of medical support for the armed forces. Economics and Society. 2025;131(4-2):1024–30 (In Russ.). EDN: FHHSHY

7. Martirosyan BR, Zargarov KV, Shurgaya TD, Chekhlenkov PA, Kuznetsov AM, Melkonyan GG. Endovascular treatment of a false aneurism of a branch of the deep femoral artery after a combined mine-explosion wound. Endovascular Surgery. 2024;11(4):513–20 (In Russ.). EDN: CZKAKF

8. Kholmatov VN, Kazantsev AN, Bolibok NV, Belyai ZhM, Tenishev RR, Gaptrakipov IKh. Surgical treatment of a mine-blast wound with the formation of a false aneurism of the popliteal artery in the conditions in a field hospital of the special military operation zone. Polytrauma. 2025;3:44–50 (In Russ.). https://doi.org/10.24412/1819-1495-2025-3-44-50

9. Amarantov DG, Zarivchatsky MF, Kholodar AA, Ladeyshchikov VM, Denisov AS, Belokrylov NM, et al. Primary assessment of the severity of the condition as the basis for choosing a strategy for diagnostic and therapeutic tactics in patients with combined trauma. Polytrauma. 2021;4:18–27 (In Russ.). https://doi.org/10.24412/1819-1495-2021-4-18-27

10. Berezka NI, Litovchenko VA, Garyachiy EV, Lapshin DV, Morozova YuV. Optimization of surgical treatment patients with polytrauma using a scale evaluation of the damage severity and victims status. Scientific Bulletins of Belgorod State University. Series: Medicine. Pharmacy. 2014;175(4):116–9 (In Russ.). EDN: SGSXNL

11. Katsura M, Jakob DA, Kelly B, Ikenoue T, Matsushima K, Demetriades D. Surgical Management of Penetrating Carotid Artery Injury: Preoperative Level of Consciousness Does Matter. Journal of the American College of Surgeons. 2025;240(1):1–10. https://doi.org/10.1097/xcs.0000000000001219

12. Ali AA, Ahmed FM, Hussein AM, Abdi HK, Mohamed AO, Warsame Keilie AM, et al. Five-Year Review of Pediatric Vascular Trauma Patterns and Management in Conflict Zones: Insights from Somalia. International Journal of General Medicine. 2025;18:6881–8. https://doi.org/10.2147/IJGM.S546199

13. Sharrock AE, Tai N, Perkins Z, White JM, Remick KN, Rickard RF, et al. Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort. Journal of Vascular Surgery. 2019;70(1):224–32. https://doi.org/10.1016/j.jvs.2018.11.024

14. Nunes C, Lopes C, O’Neill Pedrosa J, Silva M, Orelhas L, Sousa J. Arterial Injuries In Lower Extremity Trauma — Outcomes Of A Single Center Study. Portuguese Journal of Cardiac Thoracic and Vascular Surgery. 2025;32(1):41–5. https://doi.org/10.48729/pjctvs.489

15. Siracuse JJ, Farber A, Cheng TW, Jones DW, Kalesan B. Lower extremity vascular injuries caused by firearms have a higher risk of amputation and death compared with non-firearm penetrating trauma. Journal of Vascular Surgery. 2020;72(4):1298–304.e1. https://doi.org/10.1016/j.jvs.2019.12.036

16. Prat D, Bloch A, Braun M, Givon A, Goldman S, Katorza E, et al. Do Gunshot and Explosion Injuries Differ in Severity and Management? A Multicenter Study of Upper Extremity Trauma in the 2023 Israel-Gaza Conflict. Clinical Orthopaedics and Related Research. 2025;483(11):2047–55. https://doi.org/10.1097/CORR.0000000000003618

17. Ali AA, Hussein AM, Albay E, Siyad AAA, Hassan MO, Ahmed SA. A blunt traumatic giant pseudoaneurysm of the brachiocephalic artery: A case report from Somalia. International Journal of Surgery Case Reports. 2024;116:109329. https://doi.org/10.1016/j.ijscr.2024.109329

18. Priyadarshini P, Kaur S, Gupta K, Kumar A, Alam J, Bagaria D, et al. Protocolized approach saves the limb in peripheral arterial injury: A decade experience. Chinese Journal of Traumatology. 2025;28(1):62–8. https://doi.org/10.1016/j.cjtee.2022.12.010

19. Yatsun V, Yatsun O. Detection and Successful Treatment of Gunshot Wound to the Femoral Artery and Vein Four Days Post-incident: A Case Study. Military Medicine. 2025;190(11–12):e2620–3. https://doi.org/10.1093/milmed/usae564

20. Katelenets M, Ginzburg V, Leytsin A, Shepovalov D, Abu Kush N, Elsaid I, et al. A single-center experience in the management of combat-related extremity vascular injuries. Journal of Vascular Surgery. 2025;82(6):1992–9.e1. https://doi.org/10.1016/j.jvs.2025.08.014

21. Gifford SM, Aidinian G, Clouse WD, Fox CJ, Porras CA, Jones WT, et al. Effect of temporary shunting on extremity vascular injury: an outcome analysis from the Global War on Terror vascular injury initiative. Journal of Vascular Surgery. 2009;50(3):549–55. https://doi.org/10.1016/j.jvs.2009.03.051

22. Katsura M, Kondo Y, Yasuda H, Fukuma S, Matsushima K, Shiraishi A, et al. Therapeutic strategies for pseudoaneurysm following blunt liver and spleen injuries: A multicenter cohort study in the pediatric population. The Journal of Trauma and Acute Care Surgery. 2023;94(3):433–42. https://doi.org/10.1097/ta.0000000000003813

23. Buxo Z, Rexroth J, Johnson BS, Fessler RD, Carron M. Pseudoaneurysm of the Lingual Artery in a Patient with Facial Trauma from Gunshot Wounds. The Journal of Craniofacial Surgery. 2025;36(2):e122–4. https://doi.org/10.1097/SCS.0000000000010788

24. Nagra R, Kanan MF, Martin J, Serban R, Packianathan XR. Delayed Discovery and Repair of a Traumatic Arteriovenous Fistula (AVF) 58 Years After a Combat Explosion. Cureus. 2025;17(11):e97265. https://doi.org/10.7759/cureus.97265

25. Levack AE, Reider L, Odum S, Hayda R, Frisch H, Andersen RC, et al. Outcomes of amputation and limb salvage in combat injuries: Does level of injury matter? A secondary analysis of Military Extremity Trauma Amputation/Limb Salvage (METALS) study data. Injury. 2025;56(4):112220. https://doi.org/10.1016/j.injury.2025.112220