{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:31:03Z","timestamp":1787963463158,"version":"build-2784847793"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"1-2","license":[{"start":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T00:00:00Z","timestamp":1657670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,23]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Blood vessel injuries in modern military conflicts account for 12% of all wounds (1), and 50%-95% of these involve arterial damage in extremities (3, 5). Furthermore, 10%-15% of all deaths on the battlefield occur due to extremity hemorrhage (2). Therefore, tourniquets and compression dressings continue to be the main methods of controlling extremity hemorrhage (4).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>The article analyzes the use of hemostatic tourniquets on wounded extremities for personnel that were provided second-level medical care by a Forward Surgical Team (FST) of one of the field hospitals of the Armed Forces of Ukraine.<\/jats:p>\n                  <jats:p>In these clinical cases, care was provided at the FST base in one of the district hospitals and during visits to civilian frontline hospitals by a vascular surgeon. This FST provided medical care to all severely and moderately injured or wounded in the area.<\/jats:p>\n                  <jats:p>The analysis included both military and civilians delivered with hemostatic tourniquets on their extremities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results and Discussion<\/jats:title>\n                  <jats:p>Assistance was provided to 69 wounded or injured, including 5 civilians. In all, 102 tourniquets were applied on 95 extremities. Tourniquets were applied on all 95 (100%) extremities including 21 (22.1%) upper extremities and 74 (77.9%) lower extremities. In 5 cases, tourniquets were applied on 3 extremities, in 16 cases on 2 extremities, and in 48 cases on 1 extremity. Combat Application Tourniquets (CAT) were used in 81 (85.3%) cases, Esmarch type in 10 (10.5%) cases, and improvised tourniquets in 4 (4.2%) cases. Duration of tourniquet application was less than 1\u2009hour in 27 cases, 1-2\u2009hours in 18 cases, 2-3\u2009hours in 15 cases, and over 3\u2009hours in 9 cases.<\/jats:p>\n                  <jats:p>The level of primary blood loss at the time of admission was categorized as &amp;lt;1\u2009L in 44 (63.7%) cases, 1.0-1.5\u2009L in 11 (11.5%) cases, 1.5-2.0\u2009L in 7 (7.2%) cases, 2.0-2.5\u2009L in 3 (3.1%) cases, and &amp;gt;2.5\u2009L in 4 (4.2%) cases. Main arteries were damaged in 14 extremities in 12 (17.4%) wounded. Main veins were damaged in 4 (5.8%) cases without the involvement of the main arteries. Damage to the branches of arteries and veins was seen in 53 (76.8%) of the wounded. Surgical procedures performed included main artery reconstruction in 6, ligation of main arteries in 2, main vein ligation in 4, primary amputations of extremities in 9, and surgical debridement with ligation of arterial and\/or venous branches in 37 cases. Reasons for excessive blood loss (&amp;gt;1.0\u2009L) included delayed tourniquet application in 8 cases, inadequate tourniquet application in 12 cases, and bleeding secondary to injuries of the chest\/abdominal cavity or head in 5 cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>(1) Tourniquet application was appropriate in 24.6% of the wounded with tourniquets.<\/jats:p>\n                  <jats:p>(2) The success of hemostatic tourniquet use is dependent upon the experience of staff rather than the type of tourniquet used.<\/jats:p>\n                  <jats:p>(3) In patients with significant blood loss, the duration of ischemia should be calculated from the time of injury and not from the time tourniquet was applied.<\/jats:p>\n                  <jats:p>(4) During the reconstruction of the main arteries in extremities after the prolonged use of the tourniquet, a longer than usual anastomosis line is advised.<\/jats:p>\n                  <jats:p>(5) Injuries to upper extremities will be more common during active combat, compared to positional warfare in fortified positions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usac208","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T13:57:06Z","timestamp":1657720626000},"page":"332-336","source":"Crossref","is-referenced-by-count":31,"title":["Application of Hemostatic Tourniquet on Wounded Extremities in Modern \u201cTrench\u201d Warfare: The View of a Vascular Surgeon"],"prefix":"10.1093","volume":"189","author":[{"given":"Vladyslav","family":"Yatsun","sequence":"first","affiliation":[{"name":"National Military Medical Clinical Center \u00abMMCH\u00bb, Ministry of Defense of Ukraine , Kyiv 01133, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,13]]},"reference":[{"issue":"suppl_2","key":"2024012918204731400_R1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1093\/milmed\/usy138","article-title":"Wartime vascular injury","volume":"183","author":"Rasmussen","year":"2018","journal-title":"Mil Med"},{"issue":"5","key":"2024012918204731400_R2","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/00005373-197005000-00001","article-title":"Acute arterial injuries in Vietnam: 1,000 cases","volume":"10","author":"Rich","year":"1970","journal-title":"J Trauma"},{"issue":"1","key":"2024012918204731400_R3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/1531003511400625","article-title":"Trauma issue. Update on wartime vascular injury","volume":"23","author":"Fox","year":"2011","journal-title":"Perspect Vase Surg Endovasc Ther"},{"key":"2024012918204731400_R4","volume-title":"Emergency War Surgery","author":"Szul","year":"2004","edition":"3rd US Revision"},{"issue":"suppl. 5","key":"2024012918204731400_R5","first-page":"S221","article-title":"Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience","volume":"54","author":"Lakstein","year":"2003","journal-title":"J Trauma"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/1-2\/332\/56448620\/usac208.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/1-2\/332\/56448620\/usac208.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T18:21:01Z","timestamp":1706552461000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/1-2\/332\/6643115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,13]]},"references-count":5,"journal-issue":{"issue":"1-2","published-online":{"date-parts":[[2022,7,13]]},"published-print":{"date-parts":[[2024,1,23]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usac208","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,1,1]]},"published":{"date-parts":[[2022,7,13]]}}}