Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Хоменко, И. П.; Шаповалов, В. Ю.; Tsema, Ievgen; Makarov, Georgii; Palytsia, Roman; Zavodovskyi, Ievgen; Ishchenko, I N; Dinets, Andrii; Mishalov, V. G.

doi:10.1186/s40792-017-0363-6

Cited by 10 publications

(16 citation statements)

References 12 publications

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“…The armed conflict in certain districts of Donetsk and Luhansk regions of Ukraine has been ongoing since 2014 [ 1 – 3 ]. Local and international communities considered it to be as a “hybrid war”, which was extensively studied and was defined as “the warfare with opponent forces who simultaneously and adaptively apply conventional weapon and irregular tactics, terrorism and criminal elements in the fight” [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Important features of war surgery such as the “golden hour” principle and the damage-control tactics were also introduced in the present case report. We followed the principle of the “golden hour”, aiming to reduce time between injury and medical care and to increase the rate of saved lives in combat patients [ 1 ]. Damage control tactics are frequently applied in modern armed conflicts.…”

Section: Introductionmentioning

confidence: 99%

“…Damage control tactics are frequently applied in modern armed conflicts. This is a clinical approach in military medicine aiming to control bleeding and the microbial contamination with the combinations of surgical interventions and resuscitation: intraperitoneal or thoracic packing and rapid closure of wounds followed by resuscitation to correct fluid homeostasis, and to control coagulopathy with subsequent application of re-exploration [ 1 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature

Хоменко¹,

Tsema

Shklyarevych³

et al. 2018

J Med Case Reports

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BackgroundPulmonary artery embolization due to projectile embolus is a rare complication in combat patients. Such embolization is rare for combat patients in the ongoing armed conflict, in East Ukraine since 2014.Case presentationWe report a clinical case of a 34-year-old Caucasian combat patient who was injured after an explosion of a booby trap hand grenade. This soldier was diagnosed with severe abdominal and skeletal trauma: damage of the duodenum and transverse colon, internal bleeding due to inferior vena cava damage and fractures of both lower extremities. The patient was treated at a highly specialized surgical center within the “golden hour” time. Whole-body computed tomography scan was performed as a routine screening method for hemodynamically stable patients, at which we identified a projectile embolus due to the explosion of a booby trap hand grenade in the right midlobar pulmonary artery. Our patient had no clinical manifestation of pulmonary artery embolism. At follow-up, our patient was diagnosed with the following complications: multiple necrosis and perforations of the transverse colon leading to a fecal peritonitis; duodenum suture line leakage caused the formation of a duodenal fistula; postoperative wound infection. These complications required multiple secondary operations, and in accordance to the principles of damage-control tactics, the extraction of projectile-embolus was postponed. Open surgery retrieval of the metal fragment was successfully performed on the 80th day after injury. Our patient was discharged from the hospital on day 168th after injury.ConclusionsLiterature analysis shows a significant difference of clinical management for patient with projectile embolism in hybrid war settings as compared to previously described cases of combat and civil gunshot injuries. Damage control tactics and the concept of the “golden hour” are highly effective for those injured in a hybrid war.A whole-body computed tomography scan is an effective screening method for asymptomatic patients with projectile-embolism of the great vessels.The investigation of a greater cohort of combat patients with severe injuries and projectile-embolism should be performed in order to develop a better guideline for these patients and to save more lives.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature

Хоменко¹,

Tsema

Shklyarevych³

et al. 2018

J Med Case Reports

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“…Матеріали та методи. Вибір методу та часу проведення оперативного втручання залишається складною проблемою для хірургів другого рівня надання медичної допомоги, що надає підґрунтя для реалізації нових методів діагностики та моніторингу при лікуванні поранених [11,12,13].…”

Section: (48) June 2020 Rs Globalunclassified

“…Кількість вогнепальних поранень кінцівок складає від 52-70 %, а в деяких випадках і до 80% від загальної кількості поранених [4,9,5,12]. З яких 35-40% -це поранені з відкритими вогнепальними переломами кісток та 19-30% -поранення м'яких тканин різного ступеню важкості [3,8,10,11].…”

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The First Stage Reconstruction of the Soft Tissue Defects of Gunshot Wounds

Хоменко¹,

Гуменюк²,

Tsema³

et al. 2020

RS Global - Web of Scholar

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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.

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Addressing abdominal trauma from conflict and warfare in under‐resourced regions: A critical narrative review

Awuah,

Tan,

Shah

et al. 2024

Health Science Reports

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IntroductionThe prevalence of abdominal injuries in war and conflict zones, particularly in low‐ and middle‐income countries (LMICs), presents a significant healthcare challenge. These injuries, often resulting from explosive devices, firearms, and shrapnel, lead to high morbidity and mortality rates due to delayed diagnoses, inadequate medical infrastructure, and limited access to specialised care. This review aims to summarise the literature on conflict‐related abdominal injuries in LMICs, highlighting the impact of such trauma on healthcare systems and patient outcomes, and suggesting strategies for improvement.MethodsA comprehensive narrative review was conducted, focusing on studies from contemporary and historical conflict‐ridden nations. Databases such as PubMed, EMBASE, Google Scholar, the Cochrane Library, and Scopus were searched using specific keywords. Inclusion criteria encompassed various study designs and both paediatric and adult populations, with studies providing raw data prioritised. Exclusions included non‐English articles, non‐peer‐reviewed studies, and those not reporting outcomes or involving high‐income countries.ResultsThe review identified significant challenges in managing war‐related abdominal trauma in LMICs, including a shortage of healthcare personnel and infrastructure, socio‐political barriers, and research gaps. Clinical implications of such injuries include elevated mortality rates, with surgical and nonsurgical management outcomes varying significantly. Positive advancements in diagnostics and surgical techniques have improved survival rates, yet the need for further infrastructural and workforce enhancements remains critical.ConclusionAbdominal trauma in conflict‐affected LMICs necessitates focused efforts to improve healthcare delivery, including targeted funding for infrastructure and equipment, development of training programs for trauma specialists, and increased humanitarian aid. Bridging research gaps and fostering collaborative efforts are essential for advancing the management of abdominal trauma and enhancing patient outcomes in these challenging environments.

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Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Cited by 10 publications

References 12 publications

Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature

Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature

The First Stage Reconstruction of the Soft Tissue Defects of Gunshot Wounds

Addressing abdominal trauma from conflict and warfare in under‐resourced regions: A critical narrative review

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