Наукові праці. Кафедра хірургії № 4

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Clinical effects of ligation of left gastric artery and vein, splenic artery in patients with liver cirrhosis and secondary hypersplenism
(2023-09-25) Petiunin, Oleksii; Feskov, Volodymyr; Konoplia, Lina
Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report
(2023-10-01) Lurin, I.; Makarov, Vitaliy; Khoroshun, Eduard; Nehoduiko, Volodymyr; Shypilov, Sergiy; Smolianyk, Kostiantyn
Introduction and importance: The laryngopharynx wound is considered to be one of the most severe wounds of neck both in war and in peace, as it may cause life threatening changes in the whole body (asphyxia, bleeding, shock). Important aspects of surgical treatment are to ensure full breathing, acceptable ways of feeding, and the use of reliable wound closure techniques aimed to prevent digestive tract failure and to maintain the framework and aerostasis of the laryngotracheal region. Case presentation: A case of unilateral multiple wounds of the laryngopharynx was described in the article. The features of diagnostics, surgical treatment and conservative therapy in the postoperative period with this injury were presented. The wounded man was urgently operated. During surgery the pharynx was mobilized. The metal fragment was removed. The wound of the pharynx was sutured with a two-row suture. The next stage of the surgical treatment was myoplasty. In the case of the patient, the purpose of myoplasty was additional sealing of the pharyngeal suture and myoplasty of the thyroid cartilage injury zone for the purpose of aerostasis. Because of the size of the wounds and their anatomical localization, we used the mobilized lower edge of the Musculus sternocleidomastoideus for myoplasty and proposed the method of ladder myoplasty developed by us. Clinical discussion: In myoplasty method the following criteria must be followed: the muscle flap must be of sufficient length and width, so as not to cause excessive tension in the myoplasty area; the flap must be thick enough to avoid necrosis that may cause subsequent infectious complications; when taking the flap, the most sparing operative access should be used to avoid functional and anatomical disorders; the volume of the taken muscle flap must not lead to functional and anatomical disorders. Conclusion: The proposed method of ladder myoplasty using Musculus sternocleidomastoideus is unique, and proves its high efficiency in unilateral multiple laryngopharyngeal injuries, and can be recommended for wide clinical implementation in such clinical situations.
Gunshot shrapnel wound of the thigh with damage to the superficial femoral artery (features of clinical manifestations, development of complications with late medical care and preservation of the limb)
(2023) Lurin, I.; Makarov, Vitaly; Nehoduiko, Volodymyr; Smolianyk, Kostiantyn; Chobey, S.; Ott, O.
The aim:To demonstrate the features of clinical manifestations and complications that occur with delayed medical treatment in cases of gunshot shrapnel through a wound of the thigh with damage to the superficial femoral artery. Materials and methods: The wounded individual, S., was 52 years old and had sustained a gunshot wound through a shrapnel wound of the left thigh with damage to the superficial femoral artery and soft tissue defect. Medical assistance was provided during the stages of medical evacuation. Results: The soldier sustained a gunshot wound through the upper third of the left thigh, resulting in damage to the vascular-nerve bundle and a soft tissue defect. First aid was provided at the scene, and surgical procedures were performed during the stages of medical evacuation, including primary surgical treatment of wounds in the upper third of the left thigh. On the second day following the injury, the wounded man was transferred to the Vinnytsia Military Medical Clinical Center and admitted to the vascular surgery department. After an ultrasound examination and repeated surgical treatment of the wound on the left thigh, damage to the superficial femoral artery was identified. Conclusions: The presence of features of blood circulation in gunshot wounds of the main vessels of the lower limbs can favorably affect the possibility of saving the limb, as evidenced by the case presented.
Methodology and use of experimental techniques in analyzing wound dynamics of penetrating injuries
(2023) Tomashevskyi, Roman; Larin, Oleksiy; Kolisnyk, Kostyantyn; Zuev, Andrey; Gumeniuk, Kostyantyn; Lurin, Igor; Nehoduiko, Volodymyr
This research paper focuses on the experimental studies of the process of high-speed object penetration into human body simulators and the automated registration of physical phenomena parameters related with this process. It highlights the need for a comprehensive understanding of the physical processes involved and the challenges posed by the lack of biomedical information. It emphasizes the importance of studying the volume and characteristics of damage around the wound channel. The paper also proposes a methodology encompassing mathematical modeling, experimental studies using non-biological simulators, and data processing techniques to investigate wound dynamics. An experimental setup with a distributed information and measurement system is presented, enabling the collection and analysis of physical parameters during penetration impacts. The structure of a distributed information-measuring system has been developed that allows recording the parameters of physical processes that occur during the penetration of a high-speed object into the simulator. The issues of receiving and transmitting data from sensors using wireless communication channels are considered. The problem of synchronization of many distributed sensors, which is important for recording the parameters of short-term processes, is analyzed in detail. An example of obtaining data when launching a high-speed object into a simulator using an electric mass accelerator within the framework of the proposed system is given. The research aims to enhance medical practices, and protective equipment design, contributing to improved treatment outcomes and patient care.
Modeling of wound ballistics in biological tissues using engineering simulation software
(2022-11-04) Tsymbaliuk, V.; Lurin, I.; Gumeniuk, K.; Herasymenko, O.; Furkalo, S.; Oklei, D.; Negoduyko, Volodymyr; Gorobeiko, M.; Dinets, A.
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 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
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 RussoUkrainian war
(2023) Tertyshnyi, Serhii; Lurin, Igor; Khomenko, Igor; Gumeniuk, Kostiantyn; Shapovalov, Volodymyr; Nehoduiko, Volodymyr; Gorobeiko, Maksym; Dinets, Andrii
Problems of healing chronic wounds
(Modern medical technology. - 2023. - №3. - С. 66-70, 2023-06-07) Babenko, N.; Бабенко, Н.М.; Litvinova, О.; Літвінова, О.Б.; Pavlov, S.; Павлов, С.Б.; Kumechko, М.; Кумечко, М.В.; Komarchuk, Viktor Vasylovych; Комарчук, Віктор Васильович
Aim. The work aimed to analyze and highlight the problems of chronic wound healing and modern methods of stimulation of reparative processes according to literature sources. An analysis of the scientific literature was carried out, in which views on the problems of wound healing are presented, taking into account the factors affecting the formation and healing of chronic wounds, and modern methods that stimulate reparation processes. Identifying the problems of wound healing will allow a comprehensive approach to the assessment of the wound process, taking into account the factors affecting the healing of injuries. Modern scientists are actively discussing the problems of wound healing, researching factors influencing the reparative process, including the high prevalence of chronic wounds, diagnosis and treatment of wound infections, age of patients, and state of immunity. In the case of systemic diseases, such as diabetes, cardiovascular pathology, etc., there is a violation of microcirculation, and as a result, there are violations of the phasing of reparative processes at the cellular level. As a result, the alteration process does not end and the process becomes chronic. In case of a mechanical injury, when adaptation reserves are reduced, primarily of the neurohumoral system, a key role is played by the disruption of regulatory mechanisms at the cellular level. Wound treatment requires surgical treatment, stimulation of angiogenesis, and other reparative processes at the systemic and local levels. In recent years, various methods of stimulating reparative processes have been used in clinical practice to treat wounds: local administration of recombinant growth factors, use of platelet-rich plasma, biotechnological wound dressings, and artificial skin substitutes. One of the most promising areas of wound treatment is the development of methods for targeted activation of stem cells. However, there are still insufficient data for the practical application of this method. Clinically effective and safe methods are still being developed. Physical methods are promising for improving the healing of chronic wounds. However, the selection of optimal parameters for physical action continues to be an urgent task. Despite the positive results obtained using the methods described above, there is a need for additional experimental studies and randomized controlled trials. Conclusions. Chronic wounds develop as a result of severe systemic diseases, and major mechanical injuries against the background of a decrease in physiological reserves due to emotional and psychological stress, obesity, etc. Choosing the right method of influencing the reparative process, taking into account the leading mechanism of damage repair, becomes very important to ensure the best chance for optimal wound healing.
Prospects of the high-speed multimedia data transmission technologies use in the structure of the system for providing aid to injured persons having a gunshot defect of soft tissues
(2023) Lurin, I.; Khomenko, I.; Nehoduiko, Volodymyr; Tertyshnyi, S.; Weiss, B.; Kvasnevskyi, E.; Kvasnevskyi, O.
The aim: To improve the results of providing medical care in the conditions of a fullscale war in Ukraine due to the use of medical technologies Materials and methods: From the first days, the Military Medical Clinical Center of the Southern Region provided medical assistance to the persons wounded as a result of the Russian Federation’s armed aggression. The presented multidisciplinary observation includes data received from 24.02.22 to 26.05.22. During this term, the multidisciplinary team assisted by the Teladoc Health system (the connection between the Charite Clinic, Berlin, and the MMCC of the Southern Region, Ukraine) performed 39 reconstructive and remedial operations in the MMCC of the Southern Region (Department of Surgical Infection). Results: It has been found that the implementation of differentiated surgical tactics (developed in cooperation between Charite clinics, Berlin, and MMCC of the Southern Region, Ukraine, using the Teladoc health system) in wounded patients with gunshot defects of soft tissues at the III and IV levels of medical care improves functional results, increases indicators of satisfactory from 46.9 % to 53.7 %, reducing the relative number of unsatisfactory from 18.8 % to 11.6 %. Conclusions: The information exchange in the Teledoc Health system is performed in telephone mode through protected communication channels. It enabled real-time treatment strategy recommendations and improved functional outcomes, increasing 2 the satisfactory rate from 46.9 % to 53.7 %, and reducing the relative unsatisfactory rate from 18.8 % to 11.6 %.
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
(2023-08-24) Lurin, I.; Khoroshun, Eduard; Negoduiko, Volodymyr; Makarov, Volodymyr; Shypilov, Serhii; Boroday, V.; Gorobeiko, M.; Dinets, А.
Background Gunshot wounds injury to the thorax is common in armed conficts 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 battlefeld 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
Soft tissue perfusion evaluation algorithm in the scheme of gunshot defects “closure”
(2023) Khomenko, I.; Lurin, I.; Nehoduiko, Volodymyr; Tertyshnyi, S.; Popova, O.; Vastyanov, R.; Weis, B.
The purpose of the study was to determine indicators for the soft tissue perfusion evaluation in the scheme of gunshot defects “closure” using a variety of flaps from V–Y and Keystone till “propeller” and free flaps. A thermal imaging camera FLIR C2 with an integrated temperature gauge was used to obtain thermometric images together with a digital photograph of the scanned anatomical area. Microcirculation in damaged tissues plays an important role in wound substrate and the future flap in certain anatomical structure viability ensuring. That’s why its important to determine the features of the soft tissues perfusion fire transformation and the place of the corresponding blood supply from where it is possible to “raise” the flap in the future. The original dynamic multimodal concept using DDT and sonographic evaluation of soft tissue perfusion allows to look at the specific gunshot wound changes in a new way and to plan strategically the optimal path of reconstructive-plastic recovery. The thermographic and sonographic criteria uniqueness forsoft tissue perfusion assessing in the context of large gunshot defects closing are reliable and objective, allow to assess the condition of the future wound bed and edges. They can be used not only to evaluate the wound before closing the defect but also to correct further tactics in the large defects or wounds treatment that do not heal for a long time
Soft tissue perfusion evaluation algorithm in the scheme of gunshot defects “closure”
(2023) Khomenko, I.; Lurin, I.; Nehoduiko, Volodymyr; Tertyshnyi, S.; Popova, O.; Vastyanov, R.; Weis, B.
The purpose of the study was to determine indicators for the soft tissue perfusion evaluation in the scheme of gunshot defects “closure” using a variety of flaps from V–Y and Keystone till “propeller” and free flaps. A thermal imaging camera FLIR C2 with an integrated temperature gauge was used to obtain thermometric images together with a digital photograph of the scanned anatomical area. Microcirculation in damaged tissues plays an important role in wound substrate and the future flap in certain anatomical structure viability ensuring. That’s why its important to determine the features of the soft tissues perfusion fire transformation and the place of the corresponding blood supply from where it is possible to “raise” the flap in the future. The original dynamic multimodal concept using DDT and sonographic evaluation of soft tissue perfusion allows to look at the specific gunshot wound changes in a new way and to plan strategically the optimal path of reconstructive-plastic recovery. The thermographic and sonographic criteria uniqueness forsoft tissue perfusion assessing in the context of large gunshot defects closing are reliable and objective, allow to assess the condition of the future wound bed and edges. They can be used not only to evaluate the wound before closing the defect but also to correct further tactics in the large defects or wounds treatment that do not heal for a long time.
Staged rehabilitation of military personnel as part of a multimodal approach to the gunshot soft tissue defects reconstruction
(Acta Balneol. – 2023. - Vol. LXV, issue 5, part 177. – P. 291-297., 2023) Lurin, Igor; Khomenko, Igor; Gozhenko, Olena; Nehoduiko4, Volodymyr; Herasimenko, Oleh; Tertyshnyi, Serhii; Grigoriev, Evgeny
Aim: To increase the efficacy of the original staged scheme of wounded with soft tissues gunshot defects (STGD) rehabilitation using the original improvement of diagnostic and restorative rehabilitation measures. Materials and Methods: The wounded with STGD were admitted to the Military Medical Clinical Center of the Southern Region (Odesa). The wounded were randomized in three groups depending on the severity of the injury for further rehabilitation in sanatorium-resort conditions. Spectral infrared thermography diagnostic capabilities were used to control the efficacy of rehabilitation measures and to evaluate the rehabilitation prognosis. Results: The data obtained were divided into immediate clinical and delayed organizational ones with rapid implementation into the medical practice to support the military forces of Ukraine. Authors showed the full-fledged functional recovery of the patient’s injured limbs as a result of original step-by-step scheme applying of providing medical care in cases of STGD. Conclusions: Timely rehabilitation measures at all stages of providing medical care in the Armed Forces are faster and more effective. The organizational and methodological foundations of the staged rehabilitation system of wounded servicemen with STGD at different levels of medical care depending on the severity of the injury and the tactics of surgical treatment have been developed. Different three- and four-staged models of rehabilitation measures for the injured with different severity have been proposed.
Surgical tactics in fire kidney injury and the first experience in performing laparoscopic nephrectomy at the II level of medical support (role II) in combat conditions: Case report
(2023-04-23) Gumeniuk, Kostyantyn; Lurin, Igor; Savytskyi, Oleksandr; Nehoduiko, Volodymyr; Makarov, Vitaly; Smolianyk, Kostiantyn
Introduction and importance: According to the data from the American Urological Association (AUA) and the European Urological Association (EAU) (2020), kidney is the most frequently damaged organ of the genitourinary system. Kidney damage occurs in approximately 5 % of injured people and accounts for 24 % of traumatic injuries to abdominal organs. Surgical treatment remains the gold standard in unstable patients with gunshot and stab wounds. Minimally invasive surgical treatment of kidney injuries, which is usually performed after laparoscopic diagnosis, at the II level of medical care becomes possible in the first hours after injury. Case presentation: We performed two laparoscopic nephrectomies caused by gunshot shrapnel damage to the kidney in a military mobile hospital at the II level of medical support. The time since the injury was 64 ± 16 min. The wounded were extubated after the operations, activated on the first day. In one case, the drain was removed on the third day, in the other – on the fourth day. During the monitored period (30 days) after the operation, there were no complications in both wounded. Clinical discussion: Laparoscopic nephrectomy in gunshot damage to the kidney was characterized by presence of a retroperitoneal tense hematoma. When opened, there were signs of bleeding from the kidney parenchyma, difficulty of anatomical visualization of anatomical structures - ureter, renal artery and vein. Conclusion: It is possible to perform endovideosurgical operations - laparoscopic nephrectomy in combat kidney injury at a military mobile hospital with available high-tech equipment at the II level of medical support (Role II), thus bringing highly specialized care closer to the wounded. We noted a better cosmetic effect after the laparoscopic operations
Surgical treatment of patients with liver cirrhosis at the stage of parenchymatous decompensation
(2023-11-13) Petiunin, Oleksii; Parasyuk, Dmytro; Arabadzhi, Anna
Telemedicine support aids lower limb reconstruction after combat injury in Ukraine
(2023-05-18) Khomenko, I.; Lurin, I.; Gumeniuk, K.; McKnigh, G.; Makarov, Vitaliy; Nehoduykо, Volodymyr; Khoroshun, Eduard; Tertyshnyi, S.
Since the destructive and illegal full-scale invasion of Ukraine in February 2022, caring for the victims of war trauma has been an essential function of Ukrainian clinicians [1, 2]. The authors present a case where using novel dynamic digital thermography (DDT), combined with international telemedicine support, contributed to saving the lower limb of an injured Ukrainian soldier. A male soldier in his 30s presented with a ‘through and through’ fragmentation wound to the right thigh from an artillery shell exploding nearby. After initial haemorrhage control and resuscitation, the patient was transferred to a tertiary hospital. Using telemedicine support, reconstructive surgery was planned and performed successfully using a perforating f lap technique. DDT was used pre-operatively to identify a perforating vessel and post-operatively to ensure perfusion of the f lap. The patient made a good recovery and was discharged 14 d post-operatively
Termination transformation of the fragmentary capsule after a gunshot
(2023) Lurin, I.; Makarov, Vitaliy; Nehoduiko, Volodymyr; Tertyshnyi, S.; Vastyanov, R.; Chobey, R.; Korol, S.
By the method of Mikel Calvo in the modification of Davydenko S.I. by staining the carboxyl and basic groups of proteins, it was proven that the perversion of the synthesis and maturation of the connective tissue of the periosteal capsule is due to the presence of metal fragments, soot, chemicals and elements. In the capsule around the fragment located in the dermis, in the period from 4 months to 6 years, due to contact with large and small metal fragments, disorganization of collagen occurs with a decrease in the relative number of basic amino groups of proteins and an increase in the relative number of acidic proteins due to carboxyl and hydroxyl groups. Endless destruction of maturing connective tissue fibers by carboxyl groups of proteins and their predominance over basic groups contributes to tissue acidosis and enhances metabolic proteolysis processes, destroying surrounding tissues, preventing tissue healing and leading to final fibrosis and removal.