Retrieval of ferromagnetic fragments from the lung using video-assisted thoracoscopic surgery and magnetic tool: a case report of combat patient injured in the war in Ukraine

Abstract

Background Gunshot wounds injury to the thorax is common in armed conflicts or war, including the war of Russia against Ukraine. Injury to the chest is associated with a high mortality or physical disability due to damage to the lungs, heart, and major vessels. The aim of this report is to demonstrate a case of successful management of severe gunshot injury to the lungs using video-assisted thoracoscopic surgery and magnetic tool for a combat patient injured in the war in Ukraine. Case presentation A 51-year-old soldier of the Armed Forces of Ukraine received a gunshot injury due to shelling from artillery strikes in the Donbas battlefield area. After evacuation to Level II, a forward surgical team performed primary surgical debridement. Two hours after the injury, the patient was evacuated to the Level IV of medical care (Kharkiv). At Level IV, a CT scan showed penetrating gunshot wounds to the left part of the chest with injury to the upper lobe of the left lung with the presence of the 2 metal fragments of the artillery projectile with the size of 2.5 × 2.0 cm and 1.0 × 1.0 cm. These two fragments were removed by using video-assisted thoracoscopic surgery (VATS) using the inlet gunshot hole in the left lateral chest area, as well as the assistance of a magnetic tool. Conclusions VATS and magnetic technologies should be considered for hemodynamically stable combat patients with a gunshot injury to the lungs in the ongoing war. Each combat patient could be treated by individualized approach such as using the wound canal as a scope port after primary surgical debridement of the wound and antibiotic prophylaxis.

Surgical removal of an impaled unexploded mortar shell into the chest: Case review from a war-zone

“…For stable combat patients, minimally invasive procedures may be useful. An individualized treatment approach, such as using the wound canal as an endoscope port after initial surgical wound debridement and antibiotic prophylaxis, was proposed by Lurin et al [ 17 ] In this case, the patient was hemodynamically stable, but we did not have minimally invasive devices and the patient was treated by open surgery with consistent results.…”

A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the Russo-Ukrainian war

“…Reconstructing gunshot defects of zone I of the hand remains difficult for reconstructive plastic surgeons, as it is important for a transplanted tissue not to be soft as the flexor skin must resist shear and pressure forces. The war conditions are also considered an obstacle to provide an adequate microsurgical intervention within the appropriate time after the injury because of interruptions in the medical evacuation by Russian strikes on medical convoys and other medical facilities in the ongoing Russo-Ukrainian war [ 3 – 5 , 8 , 15 – 17 ].…”

“…Severe injuries could be seen with various presentations, with frequent atypical or unusual clinical courses, which might be related to the bullet type as shown in experimental studies [ 6 , 7 ]. Severe trauma cases were described for the genitourinary, abdomen, vascular structures, chest, and neck as well as for the extremities in war in Ukraine [ 2 – 5 , 8 ]. It is worth to mention that gunshot injury to the upper extremity is also frequent in armed conflicts, and such kind of injury is associated with poor prognosis for post-injury recovery of hand functions [ 9 ].…”

Oblique projections in the analysis of multislice computed tomography data in gunshot wounds

“…МСКТ використовують не тільки для діагностики бойової вогнепальної травми, але й для вивчення моделювання поранень і травм [1,3,4,7,[9][10][11].…”

“…Зазвичай при вогнепальних пораненнях для визначення оптимального плану втручання або неоперативного лікування при аналізі даних МСКТ використовуються аксіальні, корональні, сагітальні та 3D-реконструкції [5][6][7][8][9][10][11].…”