Soft Tissues Gunshot Defects Ultrasound Investigation Use in Reconstructive-Restorative Surgery

The problem of gunshot wounds treatment is one of the urgent and incompletely resolved issues of modern surgery. Diagnosis of gunshot wounds is currently not efficient enough. There was a need to improve the content and scope of medical care with the possibility of strengthening its diagnostic chain. The aim of the work is to substantiate experimentally the feasibility and effectiveness of using diagnostic infrared thermometry in gunshot wounds of the soft tissues of the extremities. Experimental studies were performed under the chronic experimental conditions on Shinshilla breed rabbits which were subjected to gunshot wounds followed by laboratory, morphological and functional examination for 5 days. The animals were divided into 3 groups depending on the type of gunshot wound that was inflicted. The animals were removed from the experiment by the introduction of chloroethyl anesthesia on the 1st, 3rd and 5th days, after which the soft tissues with the capsule surrounding the fragment were subjected to histological and electron microscopic examination. On the 1st day of the study, a significant decrease in the diameter of the blood vessels of the affected area was determined in the group of animals that were subject to injury with firearms and metal fragments from the explosion of a grenade and an improvised explosive device. It was in these groups that the highest mortality rate was registered. Under the specified conditions of injury to the limbs of animals, as well as when injured by a pneumatic weapon with a temperature of fragments of 100 oC, pronounced changes in pulse and respiratory rate were noted. In further studies on rabbits on the 3rd and 5th days of the experiment, the actual results did not differ from those obtained 24 hrs after injury. Those rabbits that survived after the reproduction of various gunshot wounds had the greatest value. The results of their thermometric measurements were evaluated in the dynamics of experimental gunshot wounds and revealed the dependence of animal survival after gunshot wounds on the temperature of the limb in the area of the wound. There are the following leading criteria in favor of animals further survival after gunshot wounds - the presence of a perforating vessel in the area surrounding the affected space; the size of the diameter of the vessels in the adjacent area; no hemorrhage in the muscle tissue located near the affected area; comparable with normal data of the functional parameters of the animal's body – heart rate, blood oxygen pressure and respiration; thermometry results. The limb thermometry has the important prognostic value after their gunshot wound in terms of experimental animals survival. The correspondence of high thermometry indexes after a gunshot wound vs the higher risk of an animal death is statistically reliable and, accordingly, insignificant thermometric dynamics throughout the experiment is in favor of a positive outcome after injury. It is extremely important to evaluate thermometry data during the first 24 hours after receiving gunshot wounds, since we found out the maximum validity of this method in the early time intervals. All this, with adequate clinical testing and verification, has the most important medical prospects, aimed primarily at saving time for diagnostic measures and procedures. Thermometry allows to judge the activity and severity of connective tissue inflammation or sclerosis in the lesions of each wound and provides the possibility of clinical application of remote thermography as a non-invasive method of diagnosis and prediction of complications in wounded with gunshot and explosives in various wounds.

Section: Wallis Statistical Criterion)mentioning

confidence: 99%

Experimental investigation of animals survival adequacy and efficacy in case of their soft tissues gunshot wounds using the thermometry technique

Лурін

Khomenko²,

Nehoduiko

et al. 2022

“…Complications of the gunshot wound are pathological factors that disturb the regeneration and healing of the laparotomy wound. As a result of the gunshot wound, pathogenic microorganisms enter the human body and provoke such purulent-septic complications as abscesses, phlegmon, haematomas, urohematomas of the abdominal cavity and retroperitoneal space, inflammatory processes of the abdominal and pleural cavities, soft tissues and requiring repeated, multi-stage surgical interventions [8,10]. Microbial contamination of wounds, the prevalence of gunshot wounds accompanied by shock, and surgical operations (often multi-stage) under difficult combat conditions make primary wound healing impossible and sometimes can lead to the death of the wounded patients.…”

mentioning

confidence: 99%

Surgical strategy for purulent-septic complications of combat abdominal trauma

Herasymenko,

Kashtalian,

Haida

et al. 2023

The incidence of combat abdominal trauma ranges from 6.7 to 9%. The nature of gunshot abdominal wounds leads to the development of functional disorders and complications (51–81%) and, as a result, a high mortality rate (12–31%). The purpose of the work is to improve the effectiveness of surgical treatment of purulent-septic complications in wounded patients with combat abdominal trauma (CAT). We analysed the treatment of 86 wounded patients with purulent-septic complications of CAT who were hospitalized at the Military Medical Clinical Centre of the Southern Region. Taking into account the location, clinical manifestations and severity of the injury, modern methods of treatment were used, namely: puncture-drainage interventions under ultrasound guidance and the NPWT system installation. The complex treatment was supplemented with antibacterial therapy and oxygen barotherapy. First of all, the wounded patients underwent US-guided puncture, drainage interventions and stage debridement for diagnostic and therapeutic purposes. NPWT therapy was used in 11 patients with large wounds and purulent-septic complications of the soft tissues of the anterior abdominal wall. So, the use of interventional ultrasound as a priority diagnostic and therapeutic method for purulent and inflammatory complications of combat abdominal trauma improved the quality of diagnosis and reduced the number of traumatic interventions, which led to a decrease in postoperative complications and the duration of inpatient treatment. 11 (14.2%) cases of puncture-drainage interventions were ineffective, and therefore it was necessary to use traditional methods of treatment — opening and draining purulent-inflammatory foci and using NPWT therapy. Vacuum therapy is an effective method of treating purulent-septic complications of gunshot wounds of the abdominal soft tissues, which, in combination with puncture-drainage interventions, can 2.5 folds reduce the number of recurrent operations (mainly multistage surgical procedures), thereby 1.8 folds reducing the length of hospital stay. The use of current methods has improved the results of surgical treatment of purulent-septic complications in wounded patients with purulent-septic complications of combat abdominal trauma. The use of the current techniques helped to reduce the number of invasive treatment methods, facilitated recovery, reduced bed days, reduced intoxication, and increased the percentage of recovered military personnel.

“…The widespread introduction of the FAST examination and diagnostic punctures under ultrasound control into diagnostics reduces the level of more traumatic diagnostic laparocentesis from 24.7 to 2.2% and unreasonable surgical interventions The key to effective treatment of abdominal injuries is a timely diagnosis of internal organ damage and measures to prevent the development of complications [1,2]. Ultrasound imaging as a diagnostic method is widely used in modern surgical practice [3,4]. However, the peculiarities of its use under conditions of modern warfare are not sufficiently studied [1,5].…”

mentioning

confidence: 99%

Fast examination and interventional ultrasound in the diagnosis and treatment of combat abdominal trauma

Kashtalian,

Herasymenko,

Haida

et al. 2023

To improve the diagnosis and surgical treatment of wounded patients with combat abdominal trauma by methods of emergency ultrasound diagnostics and minimally invasive surgery under the control of ultrasound. The purpose of the work is to improve the results of diagnosis and surgical treatment of wounded patients with combat abdominal trauma by emergency ultrasound examination techniques and minimally invasive surgical interventions under ultrasound control. A clinical and statistical analysis of the results of the surgical treatment of 293 wounded patients with combat abdominal trauma treated at the Military Medical Clinical Centre of the Southern Region was conducted. In the main group, additional therapeutic and diagnostic measures were performed — focused assessment with sonography in trauma (FAST), puncture rehabilitation and drainage surgery under the control of ultrasound. In the main group, in contrast to the control group, FAST examination was conducted in all wounded patients. The widespread introduction of the FAST examination and diagnostic punctures under ultrasound control into diagnostics reduces the level of more traumatic diagnostic laparocentesis from 24.7 to 2.2% and unreasonable surgical interventions from 3.2 to 0.7 %. An algorithm of diagnostic and therapeutic measures for wounded patients with combat abdominal trauma based on the results of the FAST examination was developed. The data obtained indicate that the widespread implementation of FAST, percutaneous puncture and sanitation interventions under ultrasound control in the diagnosis and treatment of combat abdominal trauma and its complications helps to reduce the number of invasive and more traumatic (often useless) interventions, which leads to faster recovery and shorter treatment time.