The Era of Vascular Surgery in a War Country

The objective of this presentation is to reflect on the limited choices for vascular reconstruction in Yemen, which under war and siege; emphasize challenges surgeons conduct such a risky complicated operation with lack instruments materials needed; point out that an immensely critical almost amputated upper limb young man could be saved despite facilities. A 25-year-old presented acute ischemia after massive bleeding. While he was operating factory machine, his left hand slipped into sharp spiral processing dissected like minced meat from palm up elbow, loss skin, muscles, soft tissues. initial decision above-elbow amputation. computed tomography angiogram showed defect brachial artery 5 cm above elbow joint 2 before radio-ulnar bifurcation variant anomaly blood arteries trifurcation radial, ulnar, origin common interosseous artery. intervention started immediately reduce time brachia-trifurcation autologous bypass basilic vein reversed technique muscle-flap coverage distal anastomosis due skin tissue, then followed by orthopedics fracture fixation. Because multi injury radial at wrist joint, we decide ligate let supply ulnar alone. After 63 days inpatient treatment multiple washouts; unfortunately do not have basic devices as vacuum-assisted closure device wound VAC; therefore, had every second-day washout theater. However, if available, would conducted intraoperative dressing silver foam 7 days. Vascular trauma country leads catastrophic endpoint represents significant cause morbidity mortality following injury. Ligation remains first choice many strategy, especially minor or injuries, but femoral arteries, management amputation limb. Despite limitation surgical facilities, managed save patient's massively traumatized hand.