{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:03:23Z","timestamp":1793311403001,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tourniquet (TQ) use is a standard method of prehospital hemorrhage control in combat trauma. Prolonged limb ischemia with tourniquet syndrome (TS) may lead to severe skeletal muscle injury, traumatic rhabdomyolysis, and acute kidney injury (AKI). In recent armed conflicts, prolonged evacuation intervals have increased the frequency and clinical significance of these complications, while detailed clinical and laboratory descriptions remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was performed of 84 active-duty service members with combat-related extremity injuries complicated by TS and dialysis-requiring AKI, treated at a Role 4 military medical center between 2022 and 2024. Demographic, surgical, clinical, and laboratory variables were evaluated before and after renal replacement therapy (RRT). In-hospital survival was analyzed using the Kaplan-Meier method. Between-group laboratory comparisons were exploratory and descriptive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean duration of TQ application was 7.6\u2009\u00b1\u20090.5 hours. Amputation was performed in 76.2% of cases (64\/84; 95% CI, 65.7%-84.8%), while the remaining patients underwent fasciotomy without amputation. All patients developed severe AKI requiring hemodialysis. At admission, laboratory findings reflected extensive muscle injury and systemic inflammation, including anemia, neutrophilic leukocytosis with lymphopenia, thrombocytopenia, and marked elevations of creatine kinase, creatinine, transaminases, ferritin, and C-reactive protein, accompanied by reduced total protein and albumin concentrations. In-hospital mortality was 14.3% (12\/84; 95% CI, 7.6%-23.6%), and all deaths occurred within the first 23 days of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this retrospective Role 4 cohort, TS was associated with severe rhabdomyolysis and dialysis-requiring AKI. Coordinated surgical, critical care, and renal support were associated with short-term in-hospital stabilization in most patients, but the study design does not permit causal inference regarding treatment efficacy. Extrapolation to forward-echelon or lower-resource settings should therefore be cautious.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag305","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:25:42Z","timestamp":1781612742000},"source":"Crossref","is-referenced-by-count":2,"title":["Clinical and Hematological Characteristics of Rhabdomyolysis-Associated Kidney Injury in Military Personnel With Limb Wounds"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7563-8090","authenticated-orcid":false,"given":"Galyna V","family":"Osyodlo","sequence":"first","affiliation":[{"name":"Department of Military Therapy, Ukrainian Military Medical Academy , Kyiv 04053,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7002-6631","authenticated-orcid":false,"given":"Svitlana A","family":"Husieva","sequence":"additional","affiliation":[{"name":"Department of Military Therapy, Ukrainian Military Medical Academy , Kyiv 04053,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9564-9825","authenticated-orcid":false,"given":"Ian P","family":"Goncharov","sequence":"additional","affiliation":[{"name":"Department of Military Therapy, Ukrainian Military Medical Academy , Kyiv 04053,","place":["Ukraine"]},{"name":"National Military Medical Clinical Center \u201cMain Military Clinical Hospital\u201d , Kyiv 01133,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8105-593X","authenticated-orcid":false,"given":"Pavlo O","family":"Dubovetskyi","sequence":"additional","affiliation":[{"name":"National Military Medical Clinical Center \u201cMain Military Clinical Hospital\u201d , Kyiv 01133,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9527-6613","authenticated-orcid":false,"given":"Rostyslav V","family":"Gybalo","sequence":"additional","affiliation":[{"name":"Department of Military Therapy, Ukrainian Military Medical Academy , Kyiv 04053,","place":["Ukraine"]},{"name":"National Military Medical Clinical Center \u201cMain Military Clinical Hospital\u201d , Kyiv 01133,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9181-2578","authenticated-orcid":false,"given":"Andrii V","family":"Husiev","sequence":"additional","affiliation":[{"name":"State Institution \u201cNational Scientific Center of Surgery and Transplantology (NSCST) named after O.O. Shalimov of the National Academy of Medical Sciences of Ukraine\u201d, Department of Liver Surgery and Transplantation, Kyiv 03126,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7696-1341","authenticated-orcid":false,"given":"Yana M","family":"Klimenko","sequence":"additional","affiliation":[{"name":"Therapeutic Department, Bila Tserkva Military Hospital , Bila Tserkva 09100,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062914434887100_usag305-B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cjtee.2024.07.010","article-title":"Research progress of tourniquets and their application in the Russia-Ukraine conflict","volume":"28","author":"Nie","year":"2025","journal-title":"Chin J Traumatol"},{"key":"2026062914434887100_usag305-B2","doi-asserted-by":"publisher","first-page":"S431","DOI":"10.1097\/TA.0b013e3182755dcc","article-title":"Death on the Battlefield (2001-2011): implications for the Future of Combat Casualty Care","volume":"73","author":"Eastridge","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062914434887100_usag305-B3","volume-title":"StatPearls [Internet]","author":"Huber","year":"2025"},{"key":"2026062914434887100_usag305-B4","doi-asserted-by":"publisher","first-page":"2858","DOI":"10.1007\/s00268-022-06718-3","article-title":"Ukraine\u2019s experience with management of combat casualties using NATO\u2019s four-tier healthcare system","volume":"46","author":"Kazmirchuk","year":"2022","journal-title":"World J Surg"},{"key":"2026062914434887100_usag305-B5","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/TA.0b013e3181bdcf95","article-title":"Incidence and epidemiology of combat injuries sustained during \u201cthe surge\u201d portion of Operation Iraqi Freedom by a U.S. Army brigade combat team","volume":"68","author":"Belmont","year":"2010","journal-title":"J Trauma"},{"key":"2026062914434887100_usag305-B6","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.jvs.2018.11.024","article-title":"Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort","volume":"70","author":"Sharrock","year":"2019","journal-title":"J Vasc Surg"},{"key":"2026062914434887100_usag305-B7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/TA.0b013e318250bfb4","article-title":"Combat wounds in Iraq and Afghanistan from 2005 to 2009","volume":"73","author":"Belmont","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062914434887100_usag305-B8","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1111\/trf.15161","article-title":"Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury","volume":"59","author":"Eastridge","year":"2019","journal-title":"Transfusion"},{"key":"2026062914434887100_usag305-B9","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1093\/milmed\/usad253","article-title":"Prehospital lessons from the war in Ukraine: damage control resuscitation and surgery experiences from point of injury to role 2","volume":"189","author":"Quinn","year":"2024","journal-title":"Mil Med"},{"key":"2026062914434887100_usag305-B10","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00068-023-02420-8","article-title":"Traumatic rhabdomyolysis: rare but morbid, potentially lethal, and inconsistently monitored","volume":"50","author":"Giles","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026062914434887100_usag305-B11","doi-asserted-by":"publisher","first-page":"801586","DOI":"10.3389\/fbioe.2022.801586","article-title":"Extremity compartment syndrome: a review with a focus on non-invasive methods of diagnosis","volume":"10","author":"Novak","year":"2022","journal-title":"Front Bioeng Biotechnol"},{"key":"2026062914434887100_usag305-B12","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1136\/jramc-153-04-19","article-title":"Tourniquet use in combat trauma: UK military experience","volume":"153","author":"Brodie","year":"2007","journal-title":"J R Army Med Corps"},{"key":"2026062914434887100_usag305-B13","doi-asserted-by":"publisher","first-page":"34","DOI":"10.37647\/0132-2486-2021-109-2-10-17","article-title":"Tactics of treatment of tourniquet syndrome after gunshot wounds","volume":"1","author":"Khoroshun","year":"2024","journal-title":"Terra Orthop"},{"key":"2026062914434887100_usag305-B14","doi-asserted-by":"publisher","first-page":"8372","DOI":"10.3390\/ijms23158215","article-title":"Rhabdomyolysis-induced AKI including the role of COVID-19","volume":"23","author":"M\u0142ynarska","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2026062914434887100_usag305-B15","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1097\/01.md.0000188565.48918.41","article-title":"Rhabdomyolysis: an evaluation of 475 hospitalized patients","volume":"84","author":"Melli","year":"2005","journal-title":"Medicine (Baltimore)"},{"key":"2026062914434887100_usag305-B16","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1001\/jamasurg.2019.0151","article-title":"Use of combat casualty care data to assess the US Military Trauma System during the Afghanistan and Iraq conflicts, 2001-2017","volume":"154","author":"Howard","year":"2019","journal-title":"JAMA Surg"},{"key":"2026062914434887100_usag305-B17","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1093\/biomet\/26.4.404","article-title":"The use of confidence or fiducial limits illustrated in the case of the binomial","volume":"26","author":"Clopper","year":"1934","journal-title":"Biometrika"},{"key":"2026062914434887100_usag305-B18","doi-asserted-by":"publisher","first-page":"S186","DOI":"10.1097\/TA.0000000000003252","article-title":"Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations","volume":"91","author":"Shackelford","year":"2021","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062914434887100_usag305-B19","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/978-3-319-56780-8_1","article-title":"Tactical combat casualty care in special operations","volume":"161","author":"Butler","year":"1996","journal-title":"Mil Med."},{"key":"2026062914434887100_usag305-B20","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1093\/milmed\/usad503","article-title":"Misuse of tourniquets in Ukraine may be costing more lives and limbs than they save","volume":"189","author":"Stevens","year":"2024","journal-title":"Mil Med"},{"key":"2026062914434887100_usag305-B21","doi-asserted-by":"publisher","first-page":"3847","DOI":"10.1007\/s00068-021-01828-4","article-title":"Prolonged tactical tourniquet application for extremity combat injuries in the Sahelian region","volume":"48","author":"Sabat\u00e9-Ferris","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026062914434887100_usag305-B22","doi-asserted-by":"crossref","first-page":"17","DOI":"10.55460\/TDTK-RIN8","article-title":"Optimizing the use of limb tourniquets in tactical combat casualty care: TCCC Guidelines Change 14-02","volume":"15","author":"Shackelford","year":"2015","journal-title":"J Spec Oper Med"},{"key":"2026062914434887100_usag305-B23","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1097\/TA.0000000000004134","article-title":"Rethinking limb tourniquet conversion in the prehospital environment","volume":"95","author":"Holcomb","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062914434887100_usag305-B24","doi-asserted-by":"publisher","first-page":"67","DOI":"10.55460\/CB0O-GYYX","article-title":"The use of tourniquets in the Russo-Ukrainian war","volume":"24","author":"Samarskiy","year":"2024","journal-title":"J Spec Oper Med"},{"key":"2026062914434887100_usag305-B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.55460\/V057-2PCH","article-title":"Life over limb: why not both? Revisiting tourniquet practices from the war in Ukraine","volume":"24","author":"Patterson","year":"2024","journal-title":"J Spec Oper Med"},{"key":"2026062914434887100_usag305-B26","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1097\/XCS.0000000000000707","article-title":"Putting medical boots on the ground: lessons from the war in Ukraine and applications for future conflict","volume":"237","author":"Epstein","year":"2023","journal-title":"J Am Coll Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag305\/68647604\/usag305.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag305\/68647604\/usag305.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T18:43:53Z","timestamp":1782758633000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag305\/8721698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":26,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag305","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]},"article-number":"usag305"}}