Кафедра хірургії № 4
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Item Non-operative treatment of gunshot wounds of soft tissues(2024) Khoroshun, Eduard; Makarov, Vitaly; Nehoduiko, Volodymyr; Shypilov, Sergiy; Tertyshnyi, S.; Veryovkin, I.; Vastyanov, R.The purpose of the study was to analyze own experience of soft tissues gunshot wounds non-operative treatment. Clinical observations were performed on 829 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. All of the wounded were men. The wounded were randomized on 3 groups according to the needs for primary surgical treatment of the wound. All wounded received the same treatment. Foreign bodies (metal fragments) were partially removed with the help of a modern surgical magnetic tool. A third of all soft tissue gunshot wounds were proved do not require primary surgical treatment. The criteria for primary surgical treatment not performing are soft tissues gunshot wounds of small sizes, of different localization and number without signs of inflammation. Non-operative treatment of soft tissues gunshot wounds includes antibiotic prophylaxis, anti-tetanus toxoid administration, anesthesia, treatment of wounds with antiseptic solutions, aseptic wound dressings. Non-operative treatment of wounded with soft tissue gunshot wounds using the magnetic detection turned out to be highly effective in modern conditions for a significant number of people due to the acceleration of diagnostic process, treatment and recovery and due to entirely medical accompanying advantages.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 intervention