Author: admin

Hello, everybody—this is Gavin Verhey on behalf of the Pauper Format Panel. Today, we are making a change in Pauper. We want to walk you through the background of the change and why we’re making it.

We’ll start with the top line: High Tide is banned in Pauper. This ban takes effect immediately and will be live shortly on Magic Online.

Back in March, we unbanned High Tide as part of something new called trial unbans. The idea was that we could unban a card on a probationary basis, see how it performed, and then decide if we wanted to keep it off or return it to the banned list. This is a great way to investigate cards and potentially bring cards back into the format that people enjoy. At that time, we unbanned Prophetic Prism, which has been a success. It’s seen some play and helped decks like Urzatron, but ultimately it has been just fine. The format is very different than when Prophetic Prism was initially banned.

High Tide is a much more nuanced discussion.

At the time, we said this:

“Our hope is that the deck ends up, at best, an option in the metagame beneath the very best decks. If it ends up not being played after some experimentation, that’s a fine outcome. If it ends up fringe or playable but not in the best decks, that’s the ideal outcome. These scenarios will leave it unbanned.

“If it breaks through and enables one of the three most successful decks in the metagame, however, we will likely ban High Tide again at the end of the trial—having a kill-from-hand combo deck as one of the best three decks can be frustrating. Not every color can interact with that stretch super well.”

Event Results

First, let’s dive into data and results.

High Tide’s results started off slow as people began working to coalesce on the best versions. Eventually, players have refined the deck into a strong Psychic Puppetry and splice engine that casts High Tide and splices Psychic Puppetry onto Arcane spells to stay even or net mana, generating an immense amount of mana in a single long turn to eventually kill by looping Stream of Thought. This usually kills, when unimpeded, on turn four or five, but very occasionally on turn three.

There are a couple flexible card slots, but the majority of decklists tend to have near-identical main decks. Here’s a recent version that won a Magic Online challenge:

4 Brainstorm
1 Deep Analysis
1 Gigadrowse
3 Hidden Strings
4 High Tide
4 Ideas Unbound
13 Island
4 Merchant Scroll
4 Lórien Revealed
1 Muddle the Mixture
4 Peer Through Depths
3 Pieces of the Puzzle
4 Preordain
4 Psychic Puppetry
2 Reach Through Mists
2 Snow-Covered Island
2 Stream of Thought


1 Deep Analysis
2 Blue Elemental Blast
2 Dispel
1 Envelop
3 Fallaji Archaeologist
2 Gigadrowse
1 Muddle the Mixture
3 Snap

In terms of win rate, the deck started at just above 50% when it comes to its Magic Online win rate and didn’t have a large real-world showing at events like Paupergeddon—that’s more than fine. However, I’m really glad we took the extra time, because we have watched High Tide‘s success rate tick increasingly upward. It has crept some weeks on Magic Online to above 55%, sitting at or near the top of the metagame.

Unlike many other decks, it tends to vary a lot from week to week—despite its success, it has a smaller portion of the metagame and can be very matchup dependent (more on that later). It’s a deck that takes a large amount of play skill and experience to pilot optimally, and it’s very possible that it has taken time to slowly rise for that reason. While, as far as we can tell, the play rates online and in real life tend to be lower, historically complicated and slow combo decks tend to not show up as much in droves.

The success of High Tide alone debatably meets our threshold for banning. It is the other elements in concert with its success, however, that push it over the edge.

Problematic Gameplay and Tournament Logistics

High Tide is a card which certainly has a pedigree of slow turns—any longtime Legacy player can tell you about that. Some of that is not a surprise. However, Pauper’s version is likely even potentially more egregious than versions we’ve seen in the past.

It’s not uncommon for a High Tide combo turn to take ten or even fifteen minutes to execute, even in the hands of a skilled pilot. Unlike other formats which often have some big hammer card that helps make it clear to the opponent it’s time to pack things in, like a large Mind’s Desire, the incredibly incremental nature of the combo in Pauper means that things don’t really come to that major turning point. There is a version with a single Petals of Insight, so you can start generating infinite mana with it and enough copies of Psychic Puppetry, but many would say that’s suboptimal to play—drawing an ineffectual card with this deck can be the difference between winning and losing.

Speaking from my own personal experience, I have played a lot of High Tide now. I even played eleven rounds worth of it at in-person side events during this past Paupergeddon. I would be executing my combo for ten minutes and still not be sure if I was going to win the game. I had multiple opponents concede to me during moments where I thought I was more likely to fizzle. And while I don’t want to ascribe too much to an individual game or situation, the fact that the right play is always to fully force the opponent to play it out further compounds the time it takes.

The High Tide player will always try to combo off if they look like they’re about to lose the next turn, which means that you can expect some amount of a combo turn in every game of a match. This all boils down to a miserable gameplay experience, where the High Tide player takes up the majority of gameplay time while the other player sits there.

While it’s far from the only deck that can take a lot of time to execute—a deck like Familiars can also make games go long and monopolize the clock—at least in those cases you get to take another turn and play Magic. With High Tide, you will often watch for minutes on end with the result often being you don’t get another turn. Additionally, a deck like Familiars still leans on creatures for its combo, which the Pauper card pool is better suited to handle than something entirely from hand.

This additionally compounds in matters of tournament logistics. Because a single turn can take so long, even when plays are made at a reasonable pace, if the High Tide player begins their combo as the round is running out of time, it can cause the event to run over on time. This provides a poor event experience for everybody. While this happening is mostly situational, having it happen even just a couple times in an event can cause large delays.

While neither of these on their own are reasons for a ban—for example, we’re not taking action against Cycle Storm for its long turns—these factors in conjunction with it being a strong deck to play make it a serious problem and compound the issues.

Format Impact

While High Tide has not been the most played deck, that doesn’t mean its effects haven’t rippled across the entire format.

High Tide is a deck with extremely polar matchups. Many matchups, Game 1 is just a near-automatic loss, as the opponent has no interaction with the stack or hand, so unless they can kill by turn four, they’re relying on sideboarded games—unless your deck has a good Game 1 matchup against Tide, in which case Tide is probably in very rough shape.

To give some examples, against Mono-Blue Faeries, Tide’s worst matchup, some weeks its win rate has dipped below 20%. That is massively polar! While other matchups that don’t have Game 1 interaction have done the opposite. You sit down for Game 1 and you already often know who is going to win the first game (unless there’s a horrendous draw involved).

The result of this has been twofold.

The first is that decks that are advantaged or have a chance against High Tide in Game 1—Faeries, Tolarian Terror, Mono-Red—gain a large boost in the metagame. That’s not inherently bad. Decks becoming better because they beat up on other decks happens all the time. But it has contributed to the popularity of already popular decks and cemented Terror as a top deck.

The second piece, though, which is problematic, is that it has made it a lot more about decks racing past one another to see who can win first. Something a lot of players enjoy about Pauper is the incremental nature of the format. But if you’re trying to beat High Tide, you can either disrupt it or just try and run past it since it won’t interact with you. More decks doing the latter means the whole format gets more compressed and less interactive as people are zooming to die before High Tide’s fundamental turn.

Put another way: High Tide preys on midrange, meaning decks that can go under it but are weak to midrange become good counters. But we’ve been doing so much work over the past couple years to help slow down the format and make it more interactive: the more Pauper is about people just throwing cards at one another and seeing who wins as opposed to interactive games, generally the worse off it is. That doesn’t mean fast decks shouldn’t exist, but incentivizing the format to try to win quickly and interact very little is a negative.

Of course, after sideboarding, players gain access to options against and disruption for High Tide. Often it turns into how many sideboard cards you draw—though the deck is more resilient than many would give it credit. But this gameplay isn’t the best either when you have these very polar matchups where you lose Game 1 and then sideboard in a ton of cards to try and flip them. We’ve previously banned cards out of Mono-Red (like Monastery Swiftspear) for causing a level of polarity within the format that is lower than what High Tide is bringing to the table.

Despite the play rates being moderate, the impact on the format is outsized.

The High Tide Ban and Beyond

Ultimately, we had to ask ourselves the question, “Is High Tide making the format better or more enjoyable?” In the aggregate, and in looking at all the above reasons, the answer is no.

It’s a deck that has had outlier win rates, is hard to interact with, has caused large ripple effects, and creates a poor play and tournament experience.

Taking these elements into account together, we collectively made the decision to ban High Tide.

I want to stress that we are still happy with the experiment here. Trying something out, letting the community experiment with a card, creating discussion, and learning an outcome about a card that has essentially never been legal in the wider Pauper format is a positive result, even if the outcome was banning the card again. We have no plans for future trial unbans at this time, but I also wouldn’t be surprised to see us try it again in the future.

I will say that while we did need extra time to see how the format evolved with a deck this complicated and that took time to fully see the impact of, we do want to apologize for the moving window here. While each individual reason made sense—asking for more time over the summer to see how the deck played out and aligning with the regular announcement cadence once the window moved up two weeks—it still created a shifting date as players were trying to make plans and understand if they should invest time into learning this deck and acquiring the cards. This isn’t generally what you should expect from us, and we’ll try to not let this happen in any future trial unbans.

So, what about the other cards in the format?

Well, we looked across the whole format for any other changes to be made at this time. The deck which most caught our eye as potentially in the range of a ban is the Tolarian Terror decks. These decks have been consistently strong for most of this year and over the past six months have risen to the top in both play and win rate.

However, as mentioned earlier, we believe High Tide had an outsized impact on the format and what decks people chose. Many of the decks advantaged against Terror were ones that couldn’t compete with the speed of a deck like High Tide, and many sideboard slots that could have been used for Terror were taken up by hate for Tide. We want to monitor this now that we’ve removed High Tide as an arm of the format and see how it evolves from here.

The other deck we have had our eye on are the new Spy Combo decks that have been showing up. Here’s an example from a recent Magic Online Challenge, noting there is still experimentation with the exact mix of cards.

3 Avenging Hunter
4 Balustrade Spy
2 Dread Return
2 Elves of Deep Shadow
3 Forest
2 Gatecreeper Vine
4 Generous Ent
4 Land Grant
4 Lead the Stampede
2 Lotleth Giant
3 Masked Vandal
1 Mesmeric Fiend
4 Overgrown Battlement
3 Quirion Ranger
3 Saruli Caretaker
1 Snow-Covered Forest
4 Sagu Wildling
1 Swamp
3 Tinder Wall
3 Wall of Roots
4 Winding Way


2 Faerie Macabre
2 Fang Dragon
1 Flaring Pain
3 Healer of the Glade
3 Mesmeric Fiend
2 Nylea’s Disciple
2 Scattershot Archer

This fairly new hybrid combo deck can kill fast with Balustrade Spy setting up a lethal (or at least highly damaging) Dread Return on Lotleth Giant after milling most of its library; it also has the secondary plan of Walls accelerating into its big threats. It has definitely caught our eye as something to watch. Balustrade Spy and Dread Return both have a pedigree as extremely strong cards that can fuel problematic decks. However, there are still plenty of moments to interact with the combo and some clear sideboard options. We’ll want to continue watching to see how this develops, but it certainly looks a lot more appropriate in terms of overall impact than High Tide so far.

Overall, the format has looked healthy—which is partially why we were reserved about making this change. The impacts of a deck like High Tide are a lot less surface level than other problematic decks. Our hope is that this will nudge the format back a bit more toward interaction and drop a few percentage points off the decks that were preying on Tide being around. But, as with all things, we’ll have to wait and see.

Pauper Championships kick off this week on Magic Online, and I know we’ll eagerly be watching to see what happens both there and at Paupergeddon later this month out in Italy. As always, we’ll be out there reading everything you all have to write about this as well.

Thanks for reading, playing the format, and being up for trying something as experimental as a trial unban. It was a worthwhile experiment, and maybe we’ll try it again in the future.

This has been Gavin Verhey, now signing off on behalf of the Pauper Format Panel.

Alex Ullman
Alexandre Weber
Emma Partlow
Gavin Verhey
Mirco Ciavatta
Paige Smith
Ryuji Saito

Introduction

Vascular injuries in pediatric trauma cases are relatively rare, representing just 0.6% to 1.4% of all injuries in children.^1,2 Despite their rarity, the serious implications of these injuries make them a major concern in trauma management. Pediatric vascular trauma presents unique challenges due to the smaller diameter of blood vessels, increased likelihood of vasospasm, limited intravascular volume, and the necessity to accommodate future vessel growth. Moreover, the long-term viability of vascular repairs and the diagnostic complexity of such injuries add further difficulty to their treatment.³ These injuries can be difficult to detect, as vasospasm and concurrent trauma may mask their presence, making swift diagnosis and treatment critical. In younger children, the typical signs of vascular injury—such as visible pulsatile bleeding—are often less noticeable.⁴ In Somalia, due to the high prevalence of terrorism and conflict-related violence, blast and gunshot injuries are particularly common.⁵ The ongoing conflict in Somalia dates back to the collapse of Siad Barre’s regime, with varying levels of intensity over the years. Its primary drivers are terrorism and inter-clan disputes.⁶ Despite this context, there is a lack of comprehensive studies detailing the patterns, causes, surgical strategies, and outcomes of pediatric vascular injuries within Somali conflict zones. Our hospital, located in Mogadishu—the capital of Somalia—was established through a bilateral agreement between the health ministries of Somalia and Türkiye, aimed at strengthening collaboration in healthcare and medical services. It serves as a key referral center for vascular surgery across the country, receiving patients from both Mogadishu and other regions with traumatic vascular injuries.

This five-year retrospective study seeks to address the existing knowledge gap by examining pediatric vascular trauma cases treated at selected Somali hospitals. The study’s objectives include documenting the mechanisms of injury, anatomical sites affected, types of surgical interventions performed, and patient outcomes such as limb salvage and mortality. In conflict-affected systems, delayed prehospital transport, limited imaging, and scarce graft materials compound ischemia time and increase the risk of limb loss. We aimed to quantify patterns and mechanisms of injury, describe operative strategies, and report limb-salvage and mortality, while identifying modifiable system factors (eg, time-to-care).

Methods

Study Design and Setting

This was a retrospective cohort study conducted at Mogadishu Somali-Türkiye Training and Research Hospital, the national referral center in Somalia. The study period spanned five years, from April 2019 to April 2024. Data were extracted from the hospital’s FONET electronic medical records system and are available from the corresponding author upon reasonable request.

Participants

Eligible participants included all pediatric patients (≤18 years) presenting with clinically or radiologically confirmed arterial or major venous injuries due to trauma and managed at our center. Exclusion criteria were iatrogenic catheter-related injuries, and cases with missing operative or outcome data.

Data Collection and Variables

A single investigator performed the retrospective review and collected socio-demographic (age, sex, time to admission), clinical, and operative data. Mechanisms of injury were categorized as penetrating trauma (gunshot wounds, stabbings, glass cuts, saw-related injuries, shrapnel, or blast trauma) or blunt trauma (falls, motor vehicle accidents, or sports injuries). Associated injuries recorded included bone fractures, nerve injuries, and compartment syndrome. Complications of interest included infection, graft failure, limb amputation, and in-hospital mortality. All patients underwent initial evaluation by the cardiovascular surgery team upon admission. Resuscitation followed Advanced Trauma Life Support (ATLS) principles. Diagnosis of vascular injury was based on clinical examination supplemented by: handheld Doppler; color Doppler ultrasonography; computed tomography angiography (CTA) in hemodynamically stable patients with equivocal findings; or immediate surgical exploration in the presence of “hard signs” of vascular injury (pulsatile hemorrhage, expanding hematoma, bruit/thrill, or distal ischemia). Bone fractures were confirmed by plain radiographs when clinically indicated. Surgical management followed standard vascular repair principles. After vascular exposure, proximal and distal control was established, and systemic heparin (100 IU/kg) was administered unless contraindicated. Inflow and outflow were assessed, with thrombectomy performed when necessary. Definitive repair included: primary repair or end-to-end anastomosis when feasible; interposition grafting with the great saphenous vein (preferred), or cephalic/basilic veins for brachial artery injuries; polytetrafluoroethylene (PTFE) grafts when autologous vein was unavailable. Orthopedic stabilization was performed following revascularization to minimize ischemia time. Four-compartment fasciotomy was performed when reperfusion was delayed or compartment syndrome was suspected. Concomitant nerve injuries identified intraoperatively were repaired as appropriate. For patients presenting after >6 hours or with reduced distal mobility, the decision between revascularization and primary amputation was guided by intraoperative assessment of muscle viability via fasciotomy and contractility testing. The statistical analysis of this study was performed with the use of Statistical Package for Social Sciences Version 24.0 software (SPSS Inc., Chicago, IL, USA).

Ethical Approval

Ethical approval was obtained from the Mogadishu Somali Türkiye Training and Research Hospital’s institutional review board MSTH/16842 reference number available upon request. The study adhered to the principles of the Declaration of Helsinki and local ethical guidelines. Informed consent was obtained from each patient’s legal guardian.

Results

Among the 54 patients, 38 (70.4%) were aged between 13 and 18 years. The majority were male, with 45 patients (83.3%) being boys. The most common time for admission was during the evening hours from 6:00 PM to midnight, when 24 patients (44.4%) were hospitalized. In terms of injury mechanisms, penetrating trauma accounted for the majority of cases, affecting 44 patients (81.5%). These injuries included gunshot wounds, blast injuries, stab wounds, penetrating saw injuries, glass lacerations, and shrapnel wounds. Blunt trauma was less common, seen in 10 patients (18.5%), resulting from motor vehicle accidents, falls from heights, and sports-related blunt injuries such as those sustained during football, as shown in Table 1. The most frequently injured sites were the upper and lower limbs. The brachial artery in the upper limb was involved in 14 cases, highlighting its vulnerability, while the superficial femoral artery in the lower limb was affected in 12 cases. Venous injuries were less frequent but mainly involved the femoral vein, with 4 cases. Notable injuries were also recorded in the head and neck region, including 4 injuries to the common carotid artery and 3 to the internal jugular vein. Overall, arterial injuries (56 cases) were more common than venous injuries (10 cases), as detailed in Table 2. Regarding treatment, primary repair was the most frequently used method, performed in 22 patients (40.7%). Vein graft interposition was used in 19 patients (35.2%), and a combination of primary repair and vein grafting was applied in 6 patients (11.1%), reflecting a tailored approach in some cases to improve outcomes. Two patients (3.7%) received vein grafts with fasciotomy, and one patient (1.9%) underwent vein grafting combined with a muscle flap, indicating more complex interventions. Conservative management was chosen for two patients (3.7%), with an additional two patients (3.7%) receiving conservative treatment alongside fasciotomy, suggesting that even non-surgical approaches sometimes required intervention for complications, as shown in Table 3. A notable 23 patients (42.6%) had no associated injuries. Among those with additional trauma, fractures were the most common, with 14 patients (25.9%) sustaining upper extremity fractures and 11 patients (20.4%) having lower extremity fractures. Nerve injuries were present in 4 patients (7.4%) affecting the upper extremity, and one patient (1.9%) developed compartment syndrome. There was also one case (1.9%) involving both a lower extremity fracture and nerve injury, as outlined in Table 4. Most patients (49, or 90.7%) experienced no complications following treatment. However, a small number faced adverse outcomes: 3 patients (5.6%) developed infections, one patient (1.9%) required amputation, and one patient (1.9%) died due to their injuries, as detailed in Table 5.

Table 1 Patient Demographics

Table 2 Site of Injury and Related Vessels

Table 3 Management of the Patients

Table 4 Associated Injuries

Table 5 Complications Resulted from the Injury

Discussion

In this study, the majority of patients were male (83.3%), with 70.4% between the ages of 13 and 18 years. This aligns with trends observed in other studies, where male pediatric patients are more frequently affected by traumatic vascular injuries, especially in conflict or violence-related settings.^7,8 In addition, there was an unusual penetrating vascular injury caused by a wooden stick.⁹ This pattern is consistent with the higher rates of violence in regions such as Somalia, where these injuries are commonly encountered in pediatric trauma centers.^7,8 The evening hours (6:00 PM to 12:00 AM) accounted for the majority of hospital admissions, which suggests that these injuries are often a result of violent events occurring during these times. Regarding injury mechanisms, the study found a predominant pattern of penetrating trauma, with 81.5% of patients sustaining injuries from firearms, explosive devices, and shrapnel. This is consistent with other studies that have reported a higher prevalence of penetrating injuries in conflict zones.^7,10 Although blunt trauma accounted for 18.5% of cases, it is often associated with more complex multisystem involvement, complicating both diagnosis and treatment.¹⁰ Prompt recognition of blunt trauma facilitates early intervention, thereby minimizing complications.¹¹ Furthermore, injuries related to motor vehicle accidents, falls, and sports-related trauma were present but less common, mirroring findings from other trauma studies.^12,13 The upper and lower limbs were the anatomical regions most commonly affected, with the brachial artery in the upper limb (14 cases) and the superficial femoral artery in the lower limb (12 cases) being the most frequently injured vessels. This emphasizes the particular susceptibility of these arteries in pediatric trauma.^10,14,15 In contrast, venous injuries were less common, with the femoral vein being most frequently injured. The head and neck region, though less commonly injured, still represented significant concerns, particularly for the common carotid artery and internal jugular vein (4 cases and 3 cases, respectively). Our rate of carotid and jugular injuries parallels findings from Villamaria et al, who reported similar distributions in wartime pediatric cohorts from Iraq and Afghanistan. The high frequency of arterial injuries, particularly in the lower limbs, is consistent with other studies where the lower extremities were the most commonly injured sites.^10,12 Surgical management of vascular trauma predominated, with primary repair being the most commonly utilized approach (40.7%), followed by vein graft interposition (35.2%). The choice of surgical strategy was tailored to the nature and complexity of the injuries. Multiple arterial injuries were observed in 3.7% of cases, which compounded surgical complexity. Complex cases were addressed with a combination of primary repair and vein graft interposition (11.1%), while vein graft with fasciotomy and muscle flap were used in more challenging cases (3.7% and 1.9%, respectively). Conservative management was used for a small subset of patients (3.7%), particularly those who were hemodynamically stable with no clear signs of vascular injury. This mirrors the management trends observed in similar pediatric vascular trauma series, where open surgical repair remains the most frequently used approach.^12,13,16 Fractures were the most prevalent associated injuries, especially in the upper and lower limbs. Additionally, nerve injuries were observed in several cases, and one patient developed compartment syndrome. The coexistence of fractures with vascular injuries often presents a challenge, complicating both surgical management and postoperative recovery. These findings align with previous research that underscores the complexity of pediatric vascular trauma.^10,12 Most patients (90.7%) did not experience any postoperative complications. However, a small proportion developed infections (5.6%) or required limb amputation (1.9%). The most severe outcome observed in this group was the death of one patient due to a critical vascular injury. Bramparas et al reported a 13% mortality rate in their study of pediatric vascular trauma cases from the American College of Surgeons National Trauma Data Bank. This highlights the serious nature of pediatric vascular injuries, especially those involving major arteries such as the femoral artery, which has been associated with increased mortality in other studies.^1,16

The significant peak in hospital admissions for pediatric vascular injuries in 2023, as reflected in the time series graph, suggests a potential increase in either the incidence of these injuries or improvements in detection and reporting mechanisms.

Our study demonstrates a remarkably high limb salvage rate of 98.1% despite the constraints of working in a conflict-affected, resource-limited setting, with an overall mortality of only 1.9%. These outcomes underscore the critical influence of system-level factors such as time-to-care, referral delays, and the availability of blood products on patient survival and limb viability. Compared with multicenter series from the United States and Europe, where penetrating trauma accounts for a smaller proportion of pediatric vascular injuries and repair strategies are similar, our cohort reflects the distinctive burden of conflict settings with a higher share of penetrating mechanisms and greater reliance on autogenous vein grafts. The findings highlight several actionable priorities: strict adherence to a standardized “hard signs → operating room” pathway, lowering thresholds for fasciotomy in delayed or high-risk reperfusion, systematic autologous vein harvesting protocols, establishment of a regional referral hotline, and creation of a trauma registry to strengthen coordinated care. Nonetheless, this study is limited by its retrospective, single-center design and the lack of long-term data on graft patency or functional outcomes. Future work should focus on prospective, multicenter registry development incorporating 6–12-month follow-up with duplex ultrasonography and validated functional measures such as the Pediatric Quality of Life (PedsQL) inventory and gait assessments to better define recovery trajectories and optimize outcomes for this vulnerable population.

Conclusion

Pediatric vascular trauma in Somalia is predominantly penetrating and closely linked to conflict-related mechanisms such as gunshot, blast, and shrapnel injuries, though unusual mechanisms such as wooden stick penetration were also observed. Despite severe injury patterns and resource limitations, timely surgical intervention achieved excellent limb salvage (98.1%) with very low mortality (1.9%). These findings highlight the critical importance of early recognition, rapid referral, and standardized management protocols to optimize outcomes. Strengthening system-level factors—including blood-bank capacity, referral networks, fasciotomy readiness, and vascular training—will be essential in reducing preventable limb loss and mortality in conflict-affected regions. Future multicenter prospective studies with long-term follow-up, including graft patency and functional outcomes, are warranted to guide evidence-based improvements in pediatric vascular trauma care.

Data Sharing Statement

The data for this study were obtained from the hospital’s FONET electronic system and can be accessed from the corresponding author upon reasonable request.

Author Contributions

All authors made a significant contribution to this work, whether that is, in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The authors declare that they have no funding source for this research.

Disclosure

The authors declare that they have no conflicts of interest.

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