Embolization of a profunda femoris artery injury following battlefield tourniquet application: A case report.

Background: Vascular trauma of the lower extremity remains a major cause of preventable deaths in combat environments. Among these, injury to the profunda femoris artery is rare due to its deep location in the thigh. Blast injuries in military settings can cause extensive soft tissue and vascular disruption, making both diagnosis and hemorrhage control challenging. In such circumstances, early bleeding control and revascularization are crucial to optimize outcomes. Initial hemorrhage control can begin on the battlefield through appropriate tourniquet application. Definitive management may involve either open surgical or endovascular techniques, with embolization serving a vital role when suitable equipment and hospital resources are available. Case report: A 37-year-old soldier sustained a blast injury to the right thigh during the Thailand-Cambodia border conflict and self-applied a tourniquet in the field. On arrival, he was hypotensive with diminished distal pulses. Emergency surgical exploration with intraoperative angiography revealed active bleeding from a profunda femoris artery branch. Coil embolization was performed, supplemented with Gelfoam to reinforce thrombosis and ensure complete vessel occlusion. Fasciotomy was performed for compartment decompression. A vacuum-assisted closure dressing was applied for 2 weeks, followed by split-thickness skin graft coverage. At two months, the wound was fully healed, and the patient was able to ambulate independently. Conclusion: This case highlights the importance of prehospital tourniquet application and a pragmatic, resource-based approach to vascular trauma management in wartime conditions, utilizing available resources to achieve the best possible outcome.