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Background Gunshot wound to the colon is a frequent injury in armed conflicts. An example of high-energy modern weapon is hollow-point bullets, which is associated with an increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to investigate specific features of the hollow-point and shape-stable bullets features in colon injury. Patients and methods Analyses of clinical data was performed on 384 male soldiers from Armed Forces of Ukraine with gunshot abdominal wound with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets and 43/112 (38.4%) patients were injured by the hollow-point bullets. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to right colon side or transverse colon in 21 (48.8%) injured by shape-stable (p < 0.0001) and in 41 (59.4%) patients injured by the hollow-point bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured with the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon penetration, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none patients with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 9 (8%) patients injured by the hollow-point bullets as compared to 7 (10.1%) patients injured by shape-stable bullets (p = 0.031). Colostomy was performed in 9 (13%) patients injured by shape-stable bullets and in 8 (19%) patients injured by the hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after injury by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have a hollow-point injury in case of penetrating injury (absent outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple perforations of the intestine.
Background Gunshot wound to the colon is a frequent injury in armed conflicts. An example of high-energy modern weapon is hollow-point bullets, which is associated with an increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to investigate specific features of the hollow-point and shape-stable bullets features in colon injury. Patients and methods Analyses of clinical data was performed on 384 male soldiers from Armed Forces of Ukraine with gunshot abdominal wound with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets and 43/112 (38.4%) patients were injured by the hollow-point bullets. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to right colon side or transverse colon in 21 (48.8%) injured by shape-stable (p < 0.0001) and in 41 (59.4%) patients injured by the hollow-point bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured with the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon penetration, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none patients with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 9 (8%) patients injured by the hollow-point bullets as compared to 7 (10.1%) patients injured by shape-stable bullets (p = 0.031). Colostomy was performed in 9 (13%) patients injured by shape-stable bullets and in 8 (19%) patients injured by the hollow-point bullets (p > 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after injury by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have a hollow-point injury in case of penetrating injury (absent outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple perforations of the intestine.
Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds.
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