First experiences in delayed reconstructive treatment of war injuries from the Ukraine conflict . A retrospective data analysis from 2018 - 2022 focusing on multi drug resistant bacteria and spent resources

Background: Management of chronic war injuries is complicated by a temporal shift in microbial flora from gram-positive contaminants to multidrug-resistant (MDR) gram-negative organisms. In patients with complex blast or gunshot trauma, identifying occult infectious foci and assessing bone fragment viability are critical for successful reconstructive surgery and the prevention of hardware-related infections.

Objective: This study evaluates the prevalence of MDR bacterial colonization in Ukrainian patients with chronic conflict-related injuries and assesses the utility of advanced nuclear medicine imaging in guiding surgical debridement and treatment planning.

Key Points: Among 26 patients treated over a four-year period (mean 6.9 months post-injury), 81% demonstrated MDR colonization. Microbiological analysis of 1,838 samples identified 4MRGN in 46% and 3MRGN in 58% of the cohort. To refine surgical strategy, anti-granulocyte antibody (AGA) SPECT/CT was utilized in 10 cases to localize infection around retained fragments, while 18F-sodium fluoride (Na[18F]F) PET/CT was employed in four cases to identify avital bone segments. These hybrid imaging modalities provided precise functional and anatomical data, facilitating the targeted removal of necrotic bone and infected foreign bodies that appeared clinically quiescent.

Conclusion: High rates of MDR colonization in chronic war trauma necessitate rigorous screening and specialized diagnostic protocols. Integrating AGA-SPECT/CT and Na[18F]F-PET/CT into the preoperative workup allows for the definitive identification of infectious reservoirs and non-viable bone, optimizing the biological environment for subsequent internal fixation and bony reconstruction.