Кафедра хірургії № 4

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    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.
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    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.
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    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.
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    Surgical treatment of patients with liver cirrhosis at the stage of parenchymatous decompensation
    (2023-11-13) Petiunin, Oleksii; Parasyuk, Dmytro; Arabadzhi, Anna
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    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.
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    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
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    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.
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    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
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    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 %.