scholarly journals Stage Reconstructive and Restorative Surgical Treatment of Gunshot Wounds of the Groin, Scrotum and Penis (Case Report)

Health of Man ◽  
2021 ◽  
pp. 85-90
Author(s):  
Serhii Golovko ◽  
Oleksandr Savytskiy ◽  
Oleksandr Netrebko ◽  
Yevhen Bidula ◽  
Volodymyr Bondarchuk
Keyword(s):  
Surgical Treatment ◽  
Gunshot Wound ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Initial Stage ◽  
The Right ◽  
Upper Third ◽  
Tissue Defects

The frequency of external genital lesions in armed conflicts can reach up to 5%. The complexity of gunshot wounds is the presence of significant soft tissue defects, widespread necrosis around the wound, the possibility of progression in the hours and days after injury, the high probability of infection, and the presence of foreign bodies. The tactics of gunshot wounds are determined by the location, nature and extent of damage to soft tissues, organs, large vessels, nerves, bones and includes several stages. At the initial stage, bleeding is stopped, hematomas and foreign bodies are evacuated, non-viable tissues are removed, drainages are installed and skin defects are closed. The stage of reconstructive surgery can be started when the active wound process is over. In this report, we present a clinical case of a 22-year-old man who received a gunshot wound to the right groin, upper third of the right thigh, perineum and external genitalia in a combat zone of Operation Allied Forces, Ukraine. Bullet wound led to: damage to the skin and subcutaneous tissue in the right buttock, right groin, on the inner surface of the upper third of the thigh, penis (skin defect up to 1/3 of the circumference), scrotum, partial destruction of corpora cavernosa, m. iliopsoas and adductor muscles of the thigh, sphincter of the rectum, crushing of the right testicle. The wound was contaminated with earth and foreign bodies At the initial stage, the patient underwent: primary surgical treatment of a gunshot wound, suturing of cavernous bodies with sutures, fixation of the penis in the groin, removal of the right testicle, tamponade of the wound, sigmostomy (due to sphincter damage). Subsequently, the patient underwent regular surgical treatment of wounds, a vacuum suction system VAC was installed. After 7 months (upon completion of the healing process) suturing of the sigmostoma was performed. After 2 months, the penis and the scrotum were reconstructed. Preoperative examination (ultrasound of the penis with assessment of cavernous hemodynamics, MRI) revealed: post-traumatic scarring of the soft tissues of the right groin, inner surface of the right thigh, buttocks, right inguinal canal of the penis and scrotum, deformation of the cavernous cavity, normal indicators of cavernous blood circulation. In the early postoperative period (2 months after the intervention), the patient indicated satisfaction with the cosmetic and functional results, the preservation of morning erections, moderate discomfort in the penis during erection. Prosthetics of the right testicle are planned. The clinical case once again confirms the need for qualified surgical care during the first “golden” hour and subsequent phased treatment at a specialized level using the VAC therapy system in patients with gunshot wounds and large soft tissue defects. The experience of military medicine demonstrates the importance of involving specialists of various profiles in the treatment of combined gunshot wounds of the pelvis. An important stage of treatment in the wounded is plastic and reconstructive surgery in the long term, which is aimed at improving the functional, cosmetic and psychological results of treatment.

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.

scholarly journals THE FIRST STAGE RECONSTRUCTION OF THE SOFT TISSUE DEFECTS OF GUNSHOT WOUNDS

2020 ◽  
pp. 31-35
Author(s):  
І. П. Хоменко ◽  
К. В. Гуменюк ◽  
Є. В. Цема ◽  
Р. М. Михайлусов ◽  
С. В. Тертишний ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Military Personnel ◽  
Functional Ability ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Tissue Defects

The aim. To investigate and used a multimodal diagnostic scheme during the first stage of reconstructive surgical treatment of wounded with soft tissue defects at the second level of medical care.Materials and methods. By identifying thermographic areas with gunshot wounds of the soft tissues, we observed at the second level of medical care during 4 months of 2020 (from March to July) 37 cases.Results. We used a multimodal scheme in the pre-, intra- and postoperative period helps to reduce the area of defects in 23 (62.2%) cases out of 37 against the background of restoration and preservation of microcirculation in the damaged structure, and the number of subjectively unsatisfactory military personnel in 4 (12.8%) of the total the number of wounded, a decrease in the loss of functional ability in 19 (51.2%) cases.Conclusions. The combination of dynamic digital thermography in combination with an audio doppler at the second level of medical care can improve the quality of primary surgical treatment by performing surgery with clear indications of the proposed technique; maintain a larger volume of viable tissues, reduce the area of the defect and the number of complications in the further treatment of the wounded.

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 A META-ANALYSIS OF THE SOFT TISSUE DEFECTS CLASSIFICATION AND JUSTIFICATION OF THE OPTIMAL SURGICAL RECONSTRUCTION METHOD

2021 ◽  
Vol 121 (1) ◽  
pp. 112-123
Author(s):  
Sergiy Tertyshnyi ◽  
Igor Khomenko ◽  
Кostyantyn Gumenyuk ◽  
Sergiy Korol ◽  
Yevgen Tsema ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Meta Analysis ◽  
Surgical Reconstruction ◽  
Reconstruction Method ◽  
Soft Tissue Defects ◽  
Military Conflict ◽  
Preoperative Training ◽  
Defects Classification ◽  
Tissue Defects

During the military conflict in the East of Ukraine, considerable experience in providing medical assistance to wounded and injured with soft tissue defects has been accumulated. Taking into account the considerable diversity of defects of soft tissues on numerous a number of signs, which involves the application in the process of treatment of fundamentally different algorithms of preoperative training, planning of reconstructive intervention and method of surgical reconstruction there was a need to systematize the accumulated knowledge by developing the integral classification of soft tissue defects.

Formation of Interdental Soft Tissue Defects After Surgical Treatment of Periodontitis

1990 ◽  
Vol 61 (9) ◽  
pp. 564-570 ◽  
Author(s):  
William M. M. Jenkins ◽  
Phillip F. Wragg ◽  
W. Harper Gilmour
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Soft Tissue Defects ◽  
Tissue Defects

scholarly journals ENCAPSULATION OF METALLIC SOFT-TISSUE FOREIGN BODIES WITH A LONG CARRIER LIFE

2020 ◽  
pp. 160-164
Author(s):  
V. V. Negoduyko ◽  
R. M. Mikhailusov ◽  
T. P. Yakimova ◽  
P. M. Zamyatin ◽  
S. O. Beresnev ◽  
...  
Keyword(s):  
Foreign Body ◽  
Soft Tissue ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Clinical Laboratory ◽  
Gunshot Wounds ◽  
Analysis Data ◽  
Capsule Formation ◽  
Iron And Steel ◽  
Morphological Studies

Sumary. The aim is to investigate the features of pathogenesis in capsule formation around metallic foreign bodies of soft tissues. Materials and methods. The results of a study of 6 patients with metallic foreign bodies of soft tissues with a carrier period of 16 to 50 years were analyzed. 3 injured had foreign bodies of gunshot origin and 3 patients had foreign bodies as a result of personal injury. Used clinical, laboratory, instrumental, histological, immunohistochemical, X-ray spectrometric studies. Results. All foreign soft tissue bodies were removed with the capsule. By gender: 5 men and 1 woman. By localization - the lower extremity. Pain was present in all the victims. Radiography and ultrasound were informative, magnetodetection is informative only at the superficial location of a foreign body. The foreign bodies were made of gray cast iron and steel needle wire. Histologically, immunohistochemically and radiospectrometrically, it has been found that the capsule formation around the foreign body is affected by the mechanism and extent of damage to the soft tissues, the composition of the metal and its coating, and the carrier term of the foreign body. Conclusions. Depending on the composition of the metal and its coating, there is a different rate of oxidation of the foreign body in the soft tissues: oxidation of metal foreign bodies of fire origin is faster. The formation of the capsule around the foreign body is affected by the mechanism of tissue damage: when the needle penetrates, the soft tissues are destroyed minimally, in the case of gunshot wounds, they are destroyed more. Spectral analysis data in conjunction with morphological studies are the basis for the removal of a foreign body of inflammatory origin along with the capsule.

scholarly journals Plastic surgery of extensive soft tissue defects of the lower leg in children with the use of a parotid flap after its prefabrication with tissue expanders (preliminary report)

2020 ◽  
Vol 8 (2) ◽  
pp. 197-206
Author(s):  
Olga V. Filippova ◽  
Anton V. Govorov ◽  
Yaroslav N. Proshchenko ◽  
Konstantin A. Afonichev ◽  
Natalia S. Galkina
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Plastic Surgery ◽  
Scar Tissue ◽  
Lower Leg ◽  
Soft Tissue Defects ◽  
Tissue Expanders ◽  
Donor Area ◽  
Tissue Defects

Background. Extensive deep soft tissue defects in children are an indication for the microsurgical reconstruction using autotransplantation of a tissue complex. The use of a flap prefabrication before their microsurgical transplantation to various segments and areas is a promising approach in reconstructive surgery. Aim. The aim of this study was to evaluate the possibilities and immediate results of plastic surgery of extensive soft tissue defects of the lower leg with a tissue complex, after its prefabrication with a tissue expander, and the state of the donor area in different surgical treatment options. Materials and methods. Six patients aged 13 2.3 years were operated on for deep scar deformities of the lower leg and foot. For plastic surgery, a pericarpial flap was used. In two patients, the flap was prefabricated with tissue expanders at a volume of 720 ml. After filling the expander, the second stage of surgical treatment was performed. First, the expander was removed. Next, the flap on the artery surrounding the scapula was isolated. Last, it was transplanted into a soft tissue defect of the lower leg with the imposition of microvascular anastomoses. A layer-by-layer suture was applied to the donor wound. The Vancouver scale was used to assess the quality of the scar tissue in the donor area. Results. The removal of the tissue complex after the prefabrication with expanders made it possible to perform plastic surgery of extensive soft tissue defects of the lower leg in one stage of surgical treatment with the application of a cosmetic suture in the donor area. There were no complications in the postoperative period. At the examination after six months, patients who did not undergo flap prefabrication complained of cosmetic defects and discomfort when moving in the donor area. The evaluation of the quality of scar tissue by the Vancouver scale showed that the scars in patients after flap prefabrication were similar to optimal (total score in two patients is 2). In two patients without flap prefabrication, the total score was 7, and in two patients, it was 9, which indicated unsatisfactory cosmetic parameters of the postoperative scar. Conclusion. The prefabrication of a tissue complex using tissue expanders before microsurgical transplantation enables the collection of a large volume of tissue for plastic surgery of extensive defects. It also reduces the risk of trophic complications in the postoperative period and creates optimal conditions for closing the donor site.

scholarly journals A Rare Case of Chronic Intracerebral Foreign Body

2020 ◽  
Vol 2 (1) ◽  
pp. 18-23
Author(s):  
Naufal Hilmy Imran ◽  
Wahyudi
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Gunshot Wounds ◽  
Anatomical Location ◽  
Major Injury ◽  
Left Limb ◽  
Foreign Body Extraction ◽  
History Of ◽  
Motor Strength ◽  
The Right

Introduction: Intracranial foreign bodies are usually caused by trauma that penetrates the cranium. Gunshot wounds are the most common cause, while non-missile intracranial penetration is rare. The patient’s clinical condition highly depends on the mechanism, anatomical location of the lesion, and related injuries. Possible complications include intracerebral hemorrhage, contusion, major injury on the vascular, and meningitis. In this article, we report case of intracerebral nail extraction from a patient with right cerebral foreign body. Case presentation: A 22-year-old man with a history of unspecified schizophrenia reported with reduced awareness accompanied by weakness of his left limb. During a head CT scan of the head, there are several tubular foreign bodies in the right cerebral. Craniotomy for foreign body extraction and drainage of the cerebral abscess is immediately performed. Four days after surgery, the patient had increased awareness, although there was no significant improvement in motor strength. One month after discharged from hospital there was slight improvement in motor strength. Conclusion: Extraction of foreign bodies by a surgical procedure is mandatory and should be performed thoroughly. The administration of antibiotics, anticonvulsants, physiotherapy, and psychiatric follow-up should be added to the treatment of this patient.

scholarly journals Mathematical Justification of the Wound suturing by Wound Contractors of new Generation

2020 ◽  
Author(s):  
Sergey Izmailov ◽  
Julia Perevezentseva ◽  
Andrey Rotkov ◽  
Vladimir Beschastnov ◽  
Evgeniy Popov ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Gunshot Wounds ◽  
Military Conflicts ◽  
Surgical Sutures ◽  
Living Tissues ◽  
Treatment Of Wounds ◽  
New Generation ◽  
Mathematical Justification ◽  
Closure Method ◽  
Tissue Defects

Frequent cases of man-made disasters, terrorist attacks and military conflicts lead to an increase in the number of victims. Significant soft tissue defects are known to result from gunshot wounds. So, as a result of mine-blasting injuries, defects in the skin and underlying tissues more than 10 cm in diameter are formed in 71.1% of cases. The prerequisite for the uncomplicated course of the wound process is to achieve an adequate comparison of the edges of the wound without excessive tension. To close such extensive wounds, various technical means are used: sutures on pads, various types of dermatotension. We have developed various models of wound contractors (RC) for treatment of wounds. With the help of the RC, a complete reposition and good adaptation of the edges of the wound is created. The wound closure method using these RC almost completely eliminates tissue cutting and limits the sawing effect to a minimum. This is explained by the effects of elastic forces reducing to zero when matching soft tissues and suturing. The use of hardware methods for suturing wounds requires the development of mathematical models of various types of wounds and surgical sutures. These models should provide a simulation of living tissues of the wound edges behavior to achieve the best results in the treatment of wounds by RC advanced technologies. The purpose of this study is to mathematically justify RC with the parallel holding of spokes. Another purpose is to develop a mathematical model of the wounds suturing by hardware technology.

scholarly journals Non-powder Lateral Penetrating Craniocerebral Gunshot Wound in a 10-Year-Old Girl: A Case Report

2020 ◽  
Author(s):  
Christopher Lauren ◽  
Donny Argie ◽  
Elric Brahm Malelak ◽  
Reza Mawardy ◽  
Samuel Edhi Suranta ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Gunshot Wound ◽  
Blood Clot ◽  
Signs And Symptoms ◽  
Gunshot Wounds ◽  
Low Velocity ◽  
Gun Barrel ◽  
Entrance Wound ◽  
Air Gun ◽  
The Right

Abstract Background: Non-powder lateral penetrating craniocerebral gunshot wounds (PCGW) is one of the lethal types of penetrating head injury. The mortality rate is higher in adults than in pediatric populations and influence by the clinical and radiologic findings as the important predictors for prognostication in patients with PGCW. Case Presentation: A 10-year-old girl presented with a gunshot wound to the head 1 day prior. She was accidentally shot by her brother with an air gun from approximately 2 feet from the gun barrel. She develops a loss of consciousness for 30 minutes and weakness over the left arm. In physical examination, the patient Glasgow Coma Scale (GCS) was E3 V5 M6, weakness on the left arm, and an entrance wound over the right temple without an exit wound. The skull X-ray show the pellet fragment and the computed tomography (CT) scan show the bullet track starting from the right frontotemporal towards the left parietooccipital region, damaging both hemispheres with associated intraventricular hemorrhage (IVH). She undergoes a craniotomy procedure to remove the bullet fragment, debridement of the necrotic tissue, and evacuating the blood clot the formed over the bullet track. The patient discharge after postoperative day 7 with good recovery of neurological function and good GCS and Glasgow Outcome Scale (GOS) score. After 6 months follow-up, neither a new deficit nor other signs and symptoms were developed.Conclusions: Non-powder PCGW can cause significant damage to the intracranial compartment, despite its low velocity. The mortality rate in pediatrics is lower than in adults population. The management mandated an urgent surgical procedure to remove any blood clot and debridement of any foreign bodies encountered. Such complications in short- or long term can be developed in any patients and should be treated expectantly.

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