scholarly journals Biophysical mechanisms of the formation of wound channels in non-penetrating gunshot craniocerebral wounds

2021 ◽  
Vol 35 (1) ◽  
pp. 33-42
Author(s):  
A.O. Danchyn ◽  
O.M. Goncharuk ◽  
S.A. Usatov ◽  
M.S. Altabury ◽  
G.O. Danchyn
Keyword(s):  
Surgical Treatment ◽  
Kinetic Energy ◽  
Soft Tissues ◽  
Subcutaneous Tissue ◽  
Cranial Vault ◽  
Destructive Effect ◽  
Applied Study ◽  
Craniocerebral Injuries ◽  
Medical Histories ◽  
The Moment

Objective ‒ to develop recommendations for optimization of primary surgical treatment of gunshot penetrating craniocerebral wounds on the basis of theoretical and applied study of one of the sections of wound ballistics ‒ biophysical mechanisms of wound canal formation, concomitant impenetrable wounds and intracranial injuries.Materials and methods. The medical histories of 155 wounded who received a non-pe-netrating craniocerebral injury during the hostilities in the East of Ukraine in 2014‒2020 were studied. All of the wounded were males between 18 and 60 years old (mean age ‒ 35.1 years). To study the biophysical features of the formation of different types of wound canals at a given non-lethal kinetic energy transferred to the head tissues, the type of the wounding projectile, the flight trajectory, the nature of gunshot injuries to the soft tissues of the cranial vault and skull fractures and intracranial injuries were determined according to the data of clinical stu-dies and computed tomography and compared with the results of theoretical studies using the laws of wound ballistics.Results. There were 11 (7.1 %) bullet (only tangential) wounds, and 144 (92.9 %) shrapnel. The formation of wound channels depends on the type of the wounding projectile and its kinetic energy. Non-penetrating firearms bullet and shrapnel tangential craniocerebral wounds are caused by the destructive effect of injuring shells on the tissues, which at the moment of collision with the head have both destructive kinetic energy (>80 J) and less than destructive kinetic energy. Blind craniocerebral injuries are caused only by the traumatic effects of fragments with a small (<80 J) kinetic energy.Conclusions. With gunshot non-penetrating single shrapnel blind wounds, the wounds do not have a zone of secondary necrosis, and the zone of primary necrosis is small or insignificant, which makes it possible not to carve soft tissues around the wound during primary surgical treatment, but only to remove necrotic tissues. With gunshot non-penetrating shrapnel tangential and blind craniocerebral wounds, when the soft tissue wounds of the cranial vault do not gap, small size (damage to the skin, subcutaneous tissue to aponeurosis), primary surgical treatment is not performed. Such wounds are treated with a toilet and aseptic dressings. Wound canals ending in gunshot fractures are subject to primary surgical treatment in the same way as gunshot fractures.

Surgical treatment of extensive perianal hidradenitis

2020 ◽  
Vol 99 (9) ◽  
Keyword(s):  
Surgical Treatment ◽  
Hidradenitis Suppurativa ◽  
Soft Tissues ◽  
Case Reports ◽  
Radical Excision ◽  
Skin Flaps ◽  
Perianal Area ◽  
Apocrine Glands ◽  
Patient Preparation ◽  
Two Stages

Introduction: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. Case reports: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.

scholarly journals Primary Cranial Vault Lymphoma Extending between Subcutaneous Tissue and Brain Parenchyma without Skull Destruction after Mild Head Trauma: A Case Report and Literature Review

2021 ◽  
pp. 1118-1123
Author(s):  
Kengo Setta ◽  
Takaaki Beppu ◽  
Yuichi Sato ◽  
Hiroaki Saura ◽  
Junichi Nomura ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Head Trauma ◽  
Dura Mater ◽  
Subcutaneous Tissue ◽  
Bone Destruction ◽  
B Cell Lymphoma ◽  
Brain Parenchyma ◽  
Skin Tumor ◽  
Cranial Vault ◽  
The Brain

Malignant lymphoma of the head rarely arises outside of the brain parenchyma as primary cranial vault lymphoma (PCVL). A case of PCVL that invaded from subcutaneous tissue into the brain, passing through the skull, and occurred after mild head trauma is reported along with a review of the literature. The patient was a 75-year-old man with decreased activity. One month before his visit to our hospital, he bruised the left frontal area of his head. Magnetic resonance imaging showed homogeneously enhanced tumors with contrast media in the subcutaneous tissue corresponding to the head impact area and the cerebral parenchyma, but no obvious abnormal findings in the skull. A biopsy with craniotomy was performed under general anesthesia. The pathological diagnosis was diffuse large B-cell lymphoma. On histological examination, tumor cells grew aggressively under the skin. Tumor cells invaded along the emissary vein into the external table without remarkable bone destruction and extended across the skull through the Haversian canals in the diploe. Tumor cells were found only at the perivascular areas in the dura mater and extended into the brain parenchyma. Considering the history of head trauma and the neuroimaging and histological findings, the PCVL in the present case arose primarily under the skin, passed though the skull and dura mater, and invaded along vessels and reached the brain.

NECROTISING SOFT TISSUE INFECTION OF BILATERAL UPPER LIMB CAUSED BY THE INJECTION OF ORAL BACTERIA: A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 243-246 ◽  
Author(s):  
Yuichi Yoshii ◽  
Tomoo Ishii ◽  
Shinsuke Sakai
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Soft Tissue Infection ◽  
Soft Tissues ◽  
Biceps Brachii ◽  
Subcutaneous Tissue ◽  
Oral Bacteria ◽  
Tissue Infection ◽  
Left Elbow ◽  
The Right

Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.

Biological Response to Wollastonite Doped α-Tricalcium Phosphate Implants in Hard and Soft Tissues in Rats

2008 ◽  
Vol 396-398 ◽  
pp. 7-10 ◽  
Author(s):  
Ana Maria Minarelli Gaspar ◽  
Sybele Saska ◽  
R. García Carrodeguas ◽  
A.H. De Aza ◽  
P. Pena ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Bone Formation ◽  
Bone Tissue ◽  
Tricalcium Phosphate ◽  
Rattus Norvegicus ◽  
Soft Tissues ◽  
Subcutaneous Tissue ◽  
Biological Response ◽  
New Bone Formation ◽  
Rat Bone

The biological response following subcutaneous and bone implantation of β-wollastonite(β-W)-doped α-tricalcium phosphate bioceramics in rats was evaluated. Tested materials were: tricalcium phosphate (TCP), consisting of a mixture of α- and β-polymorphs; TCP doped with 5 wt. % of β-W (TCP5W), composed of α-TCP as only crystalline phase; and TCP doped with 15 wt. % of β-W (TCP15), containing crystalline α-TCP and β-W. Cylinders of 2x1 mm were implanted in tibiae and backs of adult male Rattus norvegicus, Holtzman rats. After 7, 30 and 120 days, animals were sacrificed and the tissue blocks containing the implants were excised, fixed and processed for histological examination. TCP, TCP5W and TCP15W implants were biocompatible but neither bioactive nor biodegradable in rat subcutaneous tissue. They were not osteoinductive in connective tissue either. However, in rat bone tissue β-W-doped α-TCP implants (TCP5W and TCP15W) were bioactive, biodegradable and osteoconductive. The rates of biodegradation and new bone formation observed for TCP5W and TCP15W implants in rat bone tissue were greater than for non-doped TCP.

scholarly journals Thromboelastometric evaluation of horses submitted to experimental thrombosis and jugular thrombectomy

2016 ◽  
Vol 36 (8) ◽  
pp. 677-686 ◽  
Author(s):  
Dietrich Pizzigatti ◽  
Daniele S. Gonçalves ◽  
Thays C. Trentin ◽  
Regina K. Takahira ◽  
Ana L.G. Alves ◽  
...  
Keyword(s):  
Platelet Count ◽  
Surgical Treatment ◽  
Alpha Angle ◽  
Fogarty Catheter ◽  
Significance Level ◽  
Treatment Groups ◽  
Significant Difference ◽  
Group 2 ◽  
The Moment ◽  
Α Angle

Abstract: Jugular thrombosis in horses occurs commonly in iatrogenic situations, secondary to endotoxemic clinical condition and disseminated vascular coagulation, potentially leading to death. Thus, hemostatic evaluation becomes necessary and extremely important for monitoring the risks of systemic hypercoagulability and for the efficiency of allopathic and surgical treatment. This paper describes the hemostatic behavior in experimental jugular thrombosis of ten healthy equines, subsequently submitted to two thrombectomy techniques and receiving heparin sodium as anti-rethrombosis therapy. These animals were evaluated for 20 days by thromboelastometry (TEM), platelet count, hematocrit and fibrinogen, at four moments: pre-induction to phlebitis (D0-MPF); three days after thrombophlebitis induction (D3-MFM); 6 days after, - moment of thrombophlebitis - (D9-MT); and 54 (D16) and 126 (D19) hours after thrombectomies (PTM). Thrombectomy was performed via a Vollmar Ring (group 1, n=5) and Fogarty catheter (group 2, n=5). All the animals received heparin (150 UI/kg, SC) every 12 hours, for ten days after the respective thrombectomies. Through the blood samples were evaluated TEM, activated partial thromboplastin time (aPTT) and prothrombin time (PT), dosing of fibrinogen, hematocrit and platelet count at the abovementioned moments. For comparison between groups and moments the t test was applied at 5% significance level. No significant difference was verified between treatment groups at any of the moments. There were reductions in clotting time (CT) and clot formation time (CFT), with increase in maximum lysis (ML) until the moment D9-MT. Evaluation through INTEM® reagent presented prolongations of CT and CFT with reduction of α angle and ML starting from D16 and D19. Similarly, aPTT presented significant differences between moments pre- (D0, 3 and 9) and post- (D16 and 19) anticoagulant and surgical treatment. The platelet numbers were diminished at moments D16 and D19. In evaluation with EXTEM® reagent, prolongation of CT and CFT occurred only between the moments D0 vs. D3 and vs. D9. O PT did not present significant differences. The results obtained demonstrate that experimental jugular thrombophlebitis leads to local clinical alterations, with impairment of tissue and of the extrinsic coagulation pathway (EXTEM® ), but without evidence of systemic hypercoagulability status, since there was no increase of the alpha angle or maximum clot firmness (MCF). Furthermore, TEM was shown useful and more sensitive than conventional coagulation tests (PT, aPTT and fibrinogen) for the monitoring of anticoagulant therapy, as demonstrated in other works.

scholarly journals Pyelonephritis can be a source of a life threatening necrotizing myofasciitis

2014 ◽  
Vol 8 (5-6) ◽  
pp. 462
Author(s):  
Haytham Kamel ◽  
Mohamed Soliman Edris Awed ◽  
Ahmed Fouad Kotb
Keyword(s):  
Necrotizing Fasciitis ◽  
Adult Male ◽  
Soft Tissues ◽  
Subcutaneous Tissue ◽  
Relevant Literature ◽  
Deep Fascia ◽  
Necrotizing Myositis ◽  
Life Threatening

Necrotizing fasciitis is a progressive, rapidly spreading, inflammatory infection located in deep fascia. It may cause necrosis of skin and subcutaneous tissue and can even result in involvement of adjacent soft tissues such as muscles resulting in necrotizing myositis. We report the case of an adult male presenting with necrotizing myofasciitis secondary to left pyelonephritis. We also review the relevant literature.

Craniosynostosis following hemispherectomy in a 2.5-month-old boy with intractable epilepsy

2011 ◽  
Vol 8 (5) ◽  
pp. 450-454 ◽  
Author(s):  
Mohammad-Ali Jazayeri ◽  
John N. Jensen ◽  
Sean M. Lew
Keyword(s):  
Surgical Treatment ◽  
Brain Volume ◽  
Intractable Epilepsy ◽  
Infantile Spasms ◽  
Cranial Vault ◽  
Volume Loss ◽  
Brain Volume Loss ◽  
Course Of Action ◽  
Cranial Vault Remodeling

The authors report on the case of a 6-week-old boy who presented with infantile spasms. At 2.5 months of age, the patient underwent a right hemispherectomy. Approximately 3 months postoperatively, the patient presented with left coronal craniosynostosis. Subsequent cranial vault remodeling resulted in satisfactory cosmesis. Four years after surgery, the patient remains seizure free without the need for anticonvulsant medications. The authors believe this to be the first reported case of iatrogenic craniosynostosis due to hemispherectomy, and they describe 2 potential mechanisms for its development. This case suggests that, in the surgical treatment of infants with intractable epilepsy, minimization of brain volume loss through disconnection techniques should be considered, among other factors, when determining the best course of action.

scholarly journals A CLINICAL CASE OF REMOVING A RESIDUAL FOREIGN BODY FROM THE LEFT SUPRACLAVICULAR REGION

2017 ◽  
Vol 4 (3) ◽  
pp. 120-122
Author(s):  
V.V. Boyko ◽  
V.V. Makarov ◽  
A.L. Sochnieva ◽  
V.V. Kritsak
Keyword(s):  
Surgical Treatment ◽  
Foreign Body ◽  
Soft Tissue ◽  
Clinical Case ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Life Quality ◽  
The Other ◽  
Practical Case ◽  
The One

Boyko V.V., Makarov V.V., Sochnieva A.L., Kritsak V.V.Residual foreign bodies in soft tissues are one of the main causes of chronical infection lesions and decrease in life quality. Surgical treatment is the most common way to relieve the patient from a foreign body. Often there is a question whether to remove a foreign body? On the one hand, all foreign bodies that are in the human body must be removed. On the other hand, in the absence of symptoms, the risk of surgery performed for the purpose of removal exceeds the risk associated with finding the foreign body. We would like to describe a practical case of removing a foreign body (Kirschner`s wires) from the left supraclavicular region. The young patient lived with a fragment of Kirschner's wire left after the osteosynthesis of the fractured clavicle for 5 years. Surgery to remove the residual foreign body was successful. On the 7th postoperative day the patient was discharged from the hospital under the supervision of surgeons at the place of residence.Key words: foreign body in soft tissue, Kirschner`s wire, surgical treatment. КЛІНІЧНИЙ ВИПАДОК ВИДАЛЕННЯ ЗАЛИШКОВ СТОРОННЬОГО ТІЛА З ЛІВОЇ НАДКЛЮЧИЧНОЇ ОБЛАСТІБойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Залишкові чужорідні тіла м'яких тканин залишаються однією з основних причин виникнення вогнища хронічної інфекції та зниження рівня якості життя. Хірургічне лікування основний спосіб позбавити хворого від наявності чужорідного агента. Часто виникає питання чи видаляти чужорідне тіло. З одного боку, усі сторонні тіла, що знаходяться в тілі людини, підлягають видаленню, з іншого боку при відсутності симптомів ризик операції, проводимої з метою видалення, перевищує ризик, пов'язаний з перебуванням чужорідного тіла. Ми хотіли б поділитися випадком видалення залишкового стороннього тіла (спиці Кіршнера) лівої надключичної ділянки із власної практики. Молода пацієнтка прожила з уламком спиці Кіршнера, залишеної після металлоостеосинтезу поламаної ключиці протягом 5 років. Операція з видалення залишкового стороннього тіла пройшла успішно. На 7 післяопераційну добу пацієнтка була виписана зі стаціонару під спостереження хірурги за місцем проживання.Ключові слова: чужорідне тіло м'яких тканин, спиця Кіршнера, хірургічне лікування. кЛИНИЧЕСКИЙ СЛУЧАЙ УДАЛЕНИЯ ОСТАТКОВ ИНОРОДНОГО ТЕЛА ИЗ ЛЕВОЙ ПОДКЛЮЧИЧНОЙ ОБЛАСТИ Бойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Остаточные инородные тела мягких тканей остаются одной из основных причин возникновения очага хронической инфекции и снижения уровня качества жизни. Хирургическое лечение основной способ избавить больного от наличия чужеродного агента. Часто возникает вопрос удалять ли инородное тело? С одной стороны, все инородные тела, находящиеся в теле человека, подлежат удалению, с другой стороны при отсутствии симптомов риск операции, производимой с целью удаления, превышает риск, связанный с нахождением инородного тела. Мы хотели бы поделится случаем удаления остаточного инородного тела (спицы Киршнера) левой надключичной области из собственной практики. Молодая пациентка прожила с обломком спицы Киршнера, оставленной после металлоостеосинтеза поломанной ключицы в течении 5 лет. Операция по удалению остаточного инородного тела прошла успешно. На 7 послеоперационные сутки пациентка была выписана из стационара под наблюдение хирурги по месту жительства.Ключевые слова: инородное тело мягких тканей, спица Киршнера, оперативное лечение.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

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