scholarly journals Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions

2021 ◽  
pp. 10-17
Author(s):  
S.S. Strafun ◽  
I.M. Kurinnyi ◽  
N.O. Borzykh ◽  
Ya.V. Tsymbaliuk ◽  
V.G. Shypunov
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Upper Extremity ◽  
Odds Ratio ◽  
Gunshot Wounds ◽  
Percentage Increase ◽  
Peripheral Nerve Damage ◽  
Factors Influencing ◽  
Clinical Center ◽  
Late Treatment

Summary. Our study aimed to optimize the tactics of surgical treatment of wounded with gunshot wounds of the upper extremity by determining the factors influencing the outcome of treatment of servicemen in modern conditions of specialized and highly specialized medical care. Materials and Methods. Surgical treatment of 123 patients with gunshot wounds of the upper extremity who were treated at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” and the National Military Medical Clinical Center “Main Military Clinical Hospital” of the Ministry of Defense of Ukraine was analyzed. The mean age of patients was (35.3±8.7). At the level III of medical care, the largest share was occupied by wound closure (28.0%) and surgeries on the skeletal system (6.7%). At the level IV of medical care, the largest share was occupied by surgical procedures for closing unhealed wounds – 28%, due to the consequences of gunshot nerve injuries – 11.5%, fractures – 10.7%, and restorative interventions on muscles – 5.5%. Results. By calculating the odds ratio (Odds Ratio, OR), it was found that the presence of compartment syndrome reduces the probability of obtaining a positive result by 11 times (OR=11.3), and late treatment at the level IV of care reduces the effectiveness of treatment by 9 times (OR=9.1). In the group of patients with peripheral nerve damage, satisfactory results were 6.9 times less than in the group without such damage (OR=6.9); the presence of a tissue defect worsened the prognosis of treatment by almost 5 times (OR=4.7). The average time to start surgical treatment after a gunshot wound was 2.8±5.0 days at the level III and 47.2±70.4 days at the level IV. It was found that for patients admitted to the level IV facilities for up to 30 days, the percentage increase in upper extremity function was 42.6±11.8 after treatment and 28.5±10.0 at a later start of treatment. Conclusions. The results of the study of the factors influencing the outcome of treatment prove the need for early (up to 3 weeks) admission of wounded with gunshot wounds to the level IV of medical care.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

scholarly journals Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Comparison Group ◽  
Care Delivery ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Group ◽  
Lung Capacity ◽  
Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

scholarly journals THE FIRST STAGE RECONSTRUCTION OF THE SOFT TISSUE DEFECTS OF GUNSHOT WOUNDS

2020 ◽  
pp. 31-35
Author(s):  
І. П. Хоменко ◽  
К. В. Гуменюк ◽  
Є. В. Цема ◽  
Р. М. Михайлусов ◽  
С. В. Тертишний ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Military Personnel ◽  
Functional Ability ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Tissue Defects

The aim. To investigate and used a multimodal diagnostic scheme during the first stage of reconstructive surgical treatment of wounded with soft tissue defects at the second level of medical care.Materials and methods. By identifying thermographic areas with gunshot wounds of the soft tissues, we observed at the second level of medical care during 4 months of 2020 (from March to July) 37 cases.Results. We used a multimodal scheme in the pre-, intra- and postoperative period helps to reduce the area of defects in 23 (62.2%) cases out of 37 against the background of restoration and preservation of microcirculation in the damaged structure, and the number of subjectively unsatisfactory military personnel in 4 (12.8%) of the total the number of wounded, a decrease in the loss of functional ability in 19 (51.2%) cases.Conclusions. The combination of dynamic digital thermography in combination with an audio doppler at the second level of medical care can improve the quality of primary surgical treatment by performing surgery with clear indications of the proposed technique; maintain a larger volume of viable tissues, reduce the area of the defect and the number of complications in the further treatment of the wounded.

scholarly journals Experience of Applying Telemedicine Technologies in the Work of Voronezh Regional Clinical Center for Disaster Medicine

2021 ◽  
pp. 17-22
Author(s):  
L.E. Mekhantieva ◽  
◽  
A.N. Artemov ◽  
V.P. Ilyichev ◽  
◽  
...  
Keyword(s):  
Medical Care ◽  
Disaster Medicine ◽  
Trauma Centers ◽  
Road Accidents ◽  
Car Accidents ◽  
Clinical Center

The purpose of the study is to determine the role of telecommunication technologies in increasing the efficiency of Voronezh Regional Clinical Center for Disaster Medicine. Materials and methods of research. The data contained in analytical reports and other documentation of the Center for 2018-2020 in terms of identifying patterns of their change with the introduction of telecommunications technologies were analyzed. Results of the study and their analysis. Introduction of telemedicine technologies in the work of the Center resulted in increase of volume of rendering of medical care by its specialists. The neurosurgeons were the most demanded specialists, who performed telemedical consultations, which is mostly related to the necessity of performing consultations for the doctors of trauma centers of the II and III levels, engaged in treatment of victims of car accidents. Voronezh Regional Clinical Center for Disaster Medicine plans to further expand the use of telecommunication technologies not only in treating victims of road accidents, but also victims of other man-made and natural emergencies.

scholarly journals Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer

2021 ◽  
pp. 93-93
Author(s):  
Dragana Petrovic-Popovic ◽  
Milan Stojicic ◽  
Maja Nikolic-Zivanovic
Keyword(s):  
Surgical Treatment ◽  
Pressure Ulcer ◽  
Traffic Accidents ◽  
Pressure Ulcers ◽  
Stage Iv ◽  
Clinical Center ◽  
Bony Prominence ◽  
The University ◽  
Epidemiological Characteristics ◽  
Reconstructive Methods

Introduction/Objective. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and a major role in their treatment plays epidemiological and etiological aspects. Methods. A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated during a five-year period at the Clinic for Burns, Plastic and Reconstructive Surgery of the University Clinical Center of Serbia in Belgrade. Main data features used in the analysis were: gender, age, principal diseases, comorbidities and biochemical indicators of malnutrition. The patients' data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results. A total of 72 patients with pressure ulcers were included into this study with 54.7 ? 16.1 mean age. Three times more patients injured in traffic accidents were male (75% vs. 25%), while the most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of III or IV stage were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. The patient with pressure ulcer of stage IV was usually treated with partial osteotomy. Conclusion. A surgical reconstructive treatment with fasciocutaneous and myocutanaeous flaps represents a gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

scholarly journals Personalized reconstructive and plastic approach in the surgical treatment of vulvar cancer

2021 ◽  
Vol 20 (2) ◽  
pp. 12-16
Author(s):  
A. A. Mukhin ◽  
A. V. Taratonov
Keyword(s):  
Surgical Treatment ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Defect Closure ◽  
Anatomical Structures ◽  
Clinical Center ◽  
Vulvar Reconstruction ◽  
Medial Surfaces ◽  
Treatment Volume

Introduction. The choice of a rational method of treatment in vulvar cancer is one of the most actual and difficult problems of modern clinical oncology. In the majority of cases vulvar cancer occurs in elderly and senile patients, as well as in some patients with locally advanced form. The aim of the investigation was to assess the possibility of reconstruction after surgical treatment of vulvar cancer.Materials and Methods. A study was conducted involving 151 patients with squamous cell vulvar cancer in whom the gynecological oncology department of Chelyabinsk regional clinical center of oncology and nuclear medicine performed surgical treatment by various methods in the following volume: dilated vulvectomy with the resection of adjacent anatomical structures with reconstructive and plastic component.Results. The original ways of plasty of the postoperative wound after vulvectomy were evaluated, the minimum risk of  complications was revealed. The presented technologies permit to use additional variants of the wound defect reconstruction and have a number of advantages in comparison with two dermalfascial flaps from the medial surfaces of the femur used earlier. Discussion. Studies have shown that vulvar reconstruction using skin flaps can avoid complications and improve patients' quality of life. Reconstruction with flaps is not currently an accepted standard of treatment for vulvar cancer. Conclusion. The methods of the wound defect closure are possible after radical vulvectomy in patients with squamous cell vulvar cancer and resection of adjacent anatomical structures without reduction of surgical treatment volume. These methods of wound defect closure contribute to the reduction of postoperative complications and significantly reduce postoperative stay in a medical institution.

67: Computed Tomographic Angiography in the Emergency Evaluation of Upper Extremity Gunshot Wounds

2008 ◽  
Vol 51 (4) ◽  
pp. 491
Author(s):  
N. Berger ◽  
J. Stearman ◽  
S.J. Vicario ◽  
M. Smith ◽  
A. Phelps ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Gunshot Wounds ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Tomographic Angiography

scholarly journals Your Automated Implantable Cardioverter Defibrillator Is Not a Bulletproof Vest but It Might Save Your Life

2019 ◽  
Vol 3 (3) ◽  
pp. 191-193
Author(s):  
Tzlil Perahia ◽  
David Kleinman ◽  
Wassim Habre
Keyword(s):  
Emergency Department ◽  
Implantable Cardioverter Defibrillator ◽  
Upper Extremity ◽  
Gunshot Wounds ◽  
Direct Impact ◽  
Left Chest ◽  
Cardioverter Defibrillator ◽  
Arm Pain ◽  
Trauma Activation ◽  
Bulletproof Vest

A 43-year-old male was brought to the emergency department as the highest level trauma activation with complaints of chest and arm pain after sustaining gunshot wounds (GSW). Initial workup was notable for superficial GSWs to the left chest and upper extremity with direct impact to the patient’s automated implantable cardioverter defibrillator. The patient underwent replacement of the device without rewiring and was discharged home without complications.

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