Treatment of Combat Surgical Trauma of the Limbs in the Conditions of Modern War

Trutyak, I.R.; Los, Dmytro; Medzyn, Valentyn; Trunkvalter, Vasyl; Zhykovskiy, V.S.

doi:10.25040/ntsh2022.02.16

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…However, in today's world, the number of cases of (post-traumatic) bone defects is increasing dramatically [60,61], imposing an enormous socioeconomic burden [62][63][64], especially as we live in the "age of global aging" in which by 2050 about one-fifth of the world's population will be 60 years and older due to increased life expectancies [65]. Thus, the need for advanced and sophisticated treatment alternatives for long bone defects is increasing.…”

Section: Central Historical Eventsmentioning

confidence: 99%

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

Laubach

Hildebrand

Suresh

et al. 2023

JFB

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The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient’s age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon’s preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.

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Section: Central Historical Eventsmentioning

confidence: 99%

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

Laubach

Hildebrand

Suresh

et al. 2023

JFB

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“…Combat limb injury is the most frequent injury in modern warfare and ranges from 52.3 to 60.1% [1] and 63.3%, according to the Military Medical Clinical Center of the Western Region. [2].…”

Section: Introductionmentioning

confidence: 99%

Problematic Issues of Limb Amputation in Wounded With Combat Trauma

Trutyak,

Malickii,

Samotowka

et al. 2023

Proc Shevchenko Sci Soc Med Sci

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Among the wounded with limb injuries admitted to the Military Medical Center of the Western region during the year of Russia’s full-scale war in Ukraine, 29% had a mine-blast injury, 47% had shrapnel wounds, 8% had gunshot bullet wounds, 1.5% – thermal injuries, and14.5% – traumatic injuries. Upper limbs were injured in 22%, lower – in 32%, 15% had two limbs injured, and 31% had combined combat trauma. In all hospitalized with multi-fragment fractures, limbs were fixed with external fixation devices. 2% of patients had vascular damage. All wounded had unhealed wounds with a soft tissue defect. The average age of patients was 30 years. There were no comorbid diseases in the wounded, and concomitant diseases that did not affect the course of injury were found in 10%. Amputations of limbs were performed in 6.5%. Traumatic separation of a limb segment or its destruction with crushed bone and non-viable soft tissues, nerve damage with significant defect, soft tissue and bone defect, as well as thermal ischemia of the limb for more than 6 hours with necrosis of its soft tissues, were indications for primary limb amputation in 3% of wounded and injured, which were in the nature of primary debridement. Progressive wound infection with the development of the septic condition of the wounded despite intensive treatment, total ischemic necrosis, and recrudescent arrosive bleeding from great vessels required a secondary limb amputation in 1.5%. In 1.5% of the wounded, staged operations were performed as re-amputations. Re-amputation had to be performed in 0.6% of patients with an inappropriate limb stump level, which complicated prosthetics. To reduce the number of amputations for secondary indications, a timely diagnosis is needed of compartment syndrome and rational treatment of soft tissue wounds and gunshot fractures with surgical and medical prevention of the infectious process.

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“…We would like to express sincere gratitude to every volunteer for help, solidarity and partnership with Ukrainian doctors and scientists [2,3], as well as physicians who are on the medical frontline in this terroristic war [4]. The cover page of this Issue "The light will overcome the darkness" (author: Ivan Dzis, MD, PhD) reflects our hope for Victory for Ukraine in 2023.…”

mentioning

confidence: 99%

Science Is the Weapon for the Future of Ukraine

Zayachkivska

Coenen

2022

Proc Shevchenko Sci Soc Med Sci

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Dear Reader! Today marked the 299th day of the war for the independence of Ukraine. Besides the Armed Forces of Ukraine, the frontline of our battle against the aggressor is being held by healthcare professionals whose selfless work saves lives and the health of patients and ensures the existence of Ukraine. From now on, along with experimental and clinical medicine, there is war medicine in Ukraine, and the entire world is fascinated by its results. NATO Parliamentary Assembly has recently recognized our enemy as a terrorist state and called for creating a specialized international tribunal to punish all criminals. However, the full-scale invasion of the enemy with air raid alerts, shelling, scheduled and emergency blackouts did not stop Ukrainians in their love for education, scientific and research work, and awareness-raising activities. The words once uttered by great Ukrainian Hryhoriy Skovoroda, whose 300th anniversary we are celebrating this year, “The one who thinks of science, loves it, and the one who loves it, will never stop learning, no matter how passive he might seem”, are now more levant than ever. After all, they represent Ukrainian healthcare professionals and scientists. Progressive colleagues from across the globe – people of all races, all ages, ethnicities and religious orientations stand in solidarity with them. Together, they use all available possibilities and talents to bring victory closer and strengthen the positive image of Ukraine in the world. At this time the war situation is complex, with a labile standstill at the front in the east of Ukraine. Meanwhile is it an established fact that an independent Ukraine will continue to exist. Nevertheless, the loss of human lives and the destruction of society and infrastructure continues. Ukraine has shown an exceptional brave perseverance and strength. Now it is time to move forward with wise policies. Life must have to return to normal, without serious threats of war attacks. People have to build up Ukraine and healthcare professionals and scientists need to go back to their regular work finding improvements in daily living for the population. Our journal has a dual mission: 1) to enshrine the confident and attractive image of the journal, which is read in 154 countries of the world, in Ukraine and on the scientific map of the world; and 2) to unite progressive medical communities to share experiences and help Ukraine in the time of war. We would like to extend our sincere gratitude to members of the editorial board, who helped in the making of the journal in 2019-2020. Proudly and confidently, we present our readers with a new issue of our journal. This issue saw the light of day thanks to the extraordinary efforts and incredible responsibility of our authors, reviewers, and editors. Review the detailed report on the 6th International Symposium SMARTLION 2022. Medicine and War, which gathered participating lecturers not just from Ukraine, but also the USA, Germany, France and the UK. View video collections in the annex to the publication to review the unique doctor’s experience under conditions of the terroristic russian-Ukrainian war [1]. We would like to express sincere gratitude to every volunteer for help, solidarity and partnership with Ukrainian doctors and scientists [2,3], as well as physicians who are on the medical frontline in this terroristic war [4]. The cover page of this Issue “The light will overcome the darkness” (author: Ivan Dzis, MD, PhD) reflects our hope for Victory for Ukraine in 2023. We hope that the activities of our journal will serve as additional weapons for the future of Ukraine, and the editorial team will manage to continue developing the journal next year. We wish everyone health and victory in 2023! Glory to Ukraine! Glory to the Heroes!

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Treatment of Combat Surgical Trauma of the Limbs in the Conditions of Modern War

Cited by 6 publications

References 7 publications

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

Problematic Issues of Limb Amputation in Wounded With Combat Trauma

Science Is the Weapon for the Future of Ukraine

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