Наукові праці. Кафедра хірургії № 4
Permanent URI for this collectionhttps://repo.knmu.edu.ua/handle/123456789/1519
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Item Classification of gunshot foreign bodies migration(2024) Lurin, I.; Khoroshun, Eduard; Makarov, Vitaly; Nehoduiko, Volodymyr; Tertyshnyi, S.; Veryovkin, Igor; Vastyanov, R.The purpose of the study was to provide the classification features of the gunshot foreign bodies migration. We analyzed 90 cases of gunshot shrapnel blind wounds of different localization for a certain period, where there was a foreign body migration in different ways. The wounded which were admitted to the Military Medical Clinical Centre of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine, were examined by X-ray and, as indicated, using videoendoscopic methods. We distinguish the following classification features: the localization of the entrance hole; the place of migration initiation; the direction of migration; the number of foreign bodies; the structure of foreign bodies; the migration distance; the process of migration occurrence; the time of migration; the cause of migration; the frequency of migration; the foreign body fixation during migration; the volume of referral of migration surgical treatment. The identification of following three landmarks (the entrance hole, the place of migration starts and the place of detection), two stages (the wound channel and the migration corridor) and the direction of gunshot foreign bodies migration form a complete conception. The authors state that gunshot foreign bodies migration represents a separate type of a gunshot wound manifestation. The proposed original classification of gunshot foreign bodies migration allows to sort the data of clinical observations, which is of great importance for adequate and rapid diagnosis, determination of direct foreign body migration and its direction, and for effective treatment of gunshot wounds with phenomena of gunshot foreign body migrationItem Objectivization of surgical tactics in case of covering tissue gunshot defects restoration(2024) Lurin, I.; Khomenko, I.; Kashtalyan, M.; Nehoduiko, Volodymyr; Vastyanov, R.; Tertyshnyi, S.; Stepanov, G.; Solodyanikova, O.; Tanasichuk-Gazhieva, N.The article presents the results of the objectification of surgical tactics in the restoration of defects in the integumentary tissue due to gunshot wounds in 126 soldiers. For this purpose, all the wounded were divided into 2 groups: Group I included 68 wounded, in whom 75 reconstructive operations were performed under dynamic angiographic multimodal control. Group II consisted of 58 wounded patients who underwent 96 surgical operations using conventional tactics. Rapid restoration of damaged anatomical structures and their aesthetic appearance, reduction of scars showed good results of operations in group I of patients. The results of the work show that dynamic monitoring improves the quality of surgical reconstructive operations and can be recommended at all stages of medical care.Item A rare case of endoscopic removal of the metal fragment from the segmental bronchus after gunshot injury to the chest in combat patient injured in the war in Ukraine(2024) Lurin, I.; Khoroshun, Eduard; Makarov, Vitalii; Nehoduiko, Volodymyr; Cherniavskyi, Ye.; Gorobeiko, M.; Marchenko, О.; Dinets, А.Introduction and importancе: Russo-Ukrainian war is associated with severe injuries to the chest. Isolated chest injuries are associated with high mortality or advanced invalidization due to the severity of the trauma. The aim of the study was to demonstrate the experience and the challenges in diagnosis and management of the combat patient with gunshot injury to the lungs with subsequent migration of the shrapnel projectile to the segmental bronchus and its bronchoscopic removal by using forceps. Case presentation: A male patient 44 years of age was injured at an artillery strike in East Ukraine. The patient was evacuated to the Forward Surgical Team (Role 1) facility within one hour after the injury. The bronchoscopy was performed and to our surprise, the metal fragment in the lumen of the right segmental S2 bronchi was visualized at bronchoscopy, indicating its migration from the first place. The decision was made to attempt to remove the metal fragment endoscopically. At bronchoscopy, the metal fragment was caught by the endoscopic forceps and therefore removed endoscopically. The time of endoscopic removal of the metal fragment was 8 min. Clinical discussion: Removal of a foreign body (metal fragment) of gunshot origin from the lumen of a segmental bronchus by using bronchoscopy with endoscopic forceps is a rare phenomenon. Conclusions: The use of minimally invasive technologies in the treatment of gunshot blind penetrating wounds of the chest contributes to the reduction of operative trauma and shortens the time of operative treatment.Item Place and role of soft tissue ultrasound examination in tourniquet syndrome(2024) Lurin, I.; Khoroshun, Eduard; Nehoduiko, Volodymyr; Makarov, Vitalii; Tertyshnyi, S.; Tiron, O; Vastyanov, R.The purpose of the study was to demonstrate and analyze the possibilities of ultrasound diagnosis of tourniquet syndrome. All wounded were admitted at the Military Medical Clinical Center of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine from advanced surgical groups at different times from the wound with an existing tourniquet on the limb at different times after the tourniquet was placed (from 5 to 72 hours, on average 8.2±0.6). There were 32 male wounded. The average age of the wounded was 39.4±2.6 years. According to the location of the tourniquet, the wounded are distributed as follows: shoulder – 5 (15.6 %), thigh – 24 (75 %), leg – 3 (9.4 %) patients. All the wounded underwent an ultrasound and elastographic examinations. We used an average result after 12 measurements of each muscle group. When studying the data of muscle elastography against the background of the existing tourniquet, a significant difference in the elastography indicators of healthy superficial and deep muscles being under the tourniquet due to compression is noted. Elastography indicators in deep muscles are always higher than in superficial muscles. Changes in muscle elastography are localized by the location of the tourniquet. The use of ultrasound examination of soft tissues in tourniquet syndrome has an additional character. According to the data of elastography of soft tissues in the case of tourniquet syndrome, it is possible to determine the extent of soft tissue damage, which is important for determining the size of surgical interventionItem Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine(2024) Lurin, I.; Vorovskiy, О.; Makarov, Vitalii; Khoroshun, Eduard; Negoduyko, Volodymyr; Ryzhenko, А.; Chobey, S.; Gorobeiko, M.; Dinets, А.The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0–3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions. Keywords Thoracoabdominal injury, Chest war injury, Abdomen war injury, Video-assisted thoracoscopy, Minimally invasive surgery, Russia-Ukraine war, Russo-ukrainian warItem A review of the artificial intelligence application as a guideline tool for the wound management(2024) Lurin, I.; Gorobeiko, M.; Sokol, Ye.; Usenko, O.; Khoroshun, Eduard; Makarov, Vitalii; Nehoduiko, Volodymyr; Gumeniuk, K.; Gorobeyko, B.; Dinets, А.he global interest and substantial challenges on this subject contribute to its relevance. This analysis centers on the implementation of artificial intelligence within the medical field, with a specific focus on its application in managing wounds. Through an examination of numerous online studies and publications, we can gain insight into how artificial intelligence is being employed to enhance the diagnosis, treatment, and monitoring of wound healing. The integration of artificial intelligence in this sector has the capacity to transform medical practice by improving precision, effectiveness, and individualized patient care. As a result, it is a leading area of research and advancement on a global scale. We used the PubMed and Google Scholar electronic databases of medical publications, searching for abstracts using the following key phrases: artificial intelligence and wound management, artificial intelligence and gunshot wounds, artificial intelligence and war medicine, artificial intelligence and surgery. Based on search results, a literature analysis was performed. Conclusions. It is necessary to create numerous working groups of highly qualified specialists from each discipline and direction of medical activity, where the specific weight of each symptom, laboratory indica-tor, each radiological and ultrasound examination result is determined based on the data of real cases. And such work should have no less discipline and structure than medical research, it is optimal to get a universal software tool for this stage of work, which can be used with certain variations for the whole variety of pathological conditions and processesItem 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, KostiantynIntroduction 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.Item 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.Item 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 timeItem 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 %.