SURGICAL TACTICS FOR PURULENT-SEPTIC COMPLICATIONS OF COMBAT BELLY INJURIES

2021 ◽  
pp. 103-108
Author(s):  
O. S. Gerasimenko ◽  
Y. I. Gaida ◽  
A. V. Okolets ◽  
K. R. Muradian
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Clinical Manifestations ◽  
Gunshot Wounds ◽  
Treatment Method ◽  
Combat Trauma ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
Septic Complications ◽  
Severity Of Injury

Summary. Combat injury of the abdomen, according to the ATO / OOS is from 6.7 to 9 %. The specificity of gunshot wounds to the abdomen causes the development of functional disorders and complications (51–81 %) and, as a consequence, a high mortality rate (12–31 %). Objective: To improve the effectiveness of surgical treatment of purulent-septic complications in the wounded with combat trauma to the abdomen (BTC). Materials and methods. The Military Medical Clinical Center of the Southern Region (VMKC PR) analyzed the treatment of 86 wounded who were hospitalized with purulent-septic complications of BTZ from 2014 to 2020, taking into account the location, clinical manifestations and severity of injury, used modern treatment methods , namely: puncture and drainage interventions under the control of ultrasonography and installation of NPWT systems. Comprehensive treatment was supplemented with antibacterial therapy and oxygen barotherapy. First of all, the wounded underwent puncture and drainage interventions under ultrasonic navigation and gradual rehabilitation for diagnostic and therapeutic purposes. NPWT therapy was used in 11 patients with extensive wounds and purulent-septic complications of the soft tissues of the anterior abdominal wall. Thus, the use of interventional sonography, as the primary diagnostic and treatment method for the treatment of purulent-inflammatory complications of combat trauma to the abdomen, has improved the quality of diagnosis and reduced traumatic interventions, which has reduced postoperative complications and inpatient treatment. Results and discussion. Eleven (14.2 %) cases of puncture and drainage interventions were ineffective, in connection with which we had to resort to traditional methods of treatment — opening and drainage of purulent-inflammatory foci and the use of NPWT-therapy. Vacuum therapy is an effective method of treatment of purulent-septic complications of gunshot wounds of the soft tissues of the abdomen, which in combination with puncture-drainage interventions, can reduce by 2.5 times the number of repeated operations (mainly multi-stage surgical treatments), thereby reducing 1.8 times the length of stay of patients in the hospital. Conclusions. Thanks to the use of modern methods it was possible to improve the results of surgical treatment of purulent-septic complications in the wounded with purulent-septic complications of combat trauma to the abdomen. The use of the latest techniques has helped reduce the number of invasive treatments, accelerate recovery, reduce bed rest, reduce intoxication, and increase the rate of return of servicemen.

scholarly journals Radiation diagnostics of thoracic gunshot wounds

2020 ◽  
pp. 70-80
Author(s):  
Iryna Dykan
Keyword(s):  
Soft Tissues ◽  
General Structure ◽  
Ground Glass Opacity ◽  
Gunshot Wounds ◽  
Lung Parenchyma ◽  
Combat Trauma ◽  
Side Impact ◽  
Pulmonary Contusion ◽  
Projectile Energy ◽  
Surgical Trauma

The frequency of thoracic injuries in the general structure of combat surgical trauma remains at the level of 7-12 % and unchanged from the time of the Second World War to the current armed conflicts. The overwhelming majority of them (up to 72 %) are shrapnel gunshot wounds. The formation of a gunshot wound occurs due to the action of a shock wave; a wounding projectile; energy of side impact and vortex wake. The shape, size, features of the wound canal are determined by the kinetic energy of the wounding agent and the physical properties of the damaged tissues. The lung parenchyma is loose and elastic, so small-caliber bullets with low energy cause minimal damage. The wound canal is well differentiated on CT-slices. Its cavity is filled with blood, fragments of destroyed tissue, air bubbles. On the periphery, the contusion zone is determined (area of increased attenuation in the lung-ground-glass opacity). Shrapnel wounds can be accompanied by ruptures of the pulmonary parenchyma with hemorrhages, bilateral pulmonary contusion, damage to the bone frame and soft tissues of the chest. Vascular injury with massive hemorrhage into the pleural cavity and tense hemopneumothorax are one of the main causes of mortality in penetrating wounds. Transmediastinal gunshot wounds, armor trauma and bullet embolism require special attention during radiation examination of victims. The purpose of radiation diagnostics of modern combat trauma is to identify and fully characterize injuries and their complications. The amount of diagnostic information is determined by the level of medical care. Key words: gunshot wounds, chest cavity organs, radiation diagnostics.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

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 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 Fournier’s gangrene

2016 ◽  
Vol 97 (2) ◽  
pp. 256-261
Author(s):  
A V Prokhorov
Keyword(s):  
Soft Tissues ◽  
Subcutaneous Tissue ◽  
Disease Onset ◽  
Disease Diagnosis ◽  
Fournier’S Gangrene ◽  
Time Interval ◽  
Vacuum Therapy ◽  
Superficial Fascia ◽  
Fournier's Gangrene ◽  
Septic Complications

The review highlights the issues of etiology, pathogenesis, clinical and laboratory picture, radiodiagnosis, treatment and prognosis of fulminant perineum gangrene, or Fournier’s gangrene. According to modern concepts, Fournier’s gangrene is one of the rare forms of necrotizing fasciitis of polymicrobial etiology with a primary lesion of the skin, subcutaneous tissue and superficial fascia of the scrotum, penis, and perineum. Fournier’s gangrene refers to acute surgical diseases of pyonecrotic nature and is characterized by rapid septic course, high mortality, reaching 80%, in spite of the modern antibiotic therapy advances. Over the last decade the Fournier’s gangrene incidence increased in 2.2-6.4 times, due to the increasing number of immunocompromised patients in the population. The disease most often occurs in older men with diabetes, alcoholism and obesity. The Fournier’s gangrene occurrence is preceded by different inflammatory diseases of the colon, urinary organs, scrotum and perineum skin. The disease diagnosis in full-scale stage usually is not difficult. In rare cases, namely in the disease early stages, various radiological methods of investigation, laboratory tests and exploratory surgery with affected soft tissues express biopsy are used with differential diagnosis purposes. The cornerstone in the Fournier’s gangrene treatment is an emergency surgical intervention in combination with a powerful anti-bacterial and anti-shock therapy. To improve the wound healing course and reduce the septic complications risk, new methods of adjuvant treatments such as hyperbaric oxygen therapy and vacuum therapy are used. Hospitalization duration in Fournier’s gangrene is usually lengthy, due to the need to use repeated sanitation necrectomy and reconstructive plastic surgery and are associated with considerable economic costs for treatment. The Fournier’s gangrene prognosis depends on the timing of specialized medical care provision and, above all, on the time interval between the disease onset and surgery performing.

Purulent-septic complications in patient with renal calyx diverticulum

2021 ◽  
Vol 11 (1) ◽  
pp. 87-92
Author(s):  
Sergey A. Zamyatnin ◽  
Irina S. Gonchar ◽  
Andrey V. Tsygankov
Keyword(s):  
Urinary Tract ◽  
Surgical Treatment ◽  
Urinary Tract Infections ◽  
Rare Case ◽  
Left Kidney ◽  
Clinical Manifestations ◽  
Septic Complications ◽  
Middle Group ◽  
Associated Diseases ◽  
Tract Infections

The calyx diverticulum is a cavity lined with urothelium that communicates through a narrow canal with the renal calyx-pelvis system. Most calyx diverticula are 0.5 to 2.0 cm in diameter and require surgical treatment exclusively for clinical manifestations of associated diseases. The most common complications of this nosology include urolithiasis and recurrent urinary tract infections. This article presents a rare case of a large diverticulum of the middle group of the calyces of the left kidney. The dimensions of the cavity filled with urine were 10 cm, which resulted in recurrent pyelonephritis, paranephritis and urosepsis.

Peculiarities of the course of radiation-mechanical injuries during modeling of bone-muscular trauma of the limbs in expirement

2020 ◽  
Vol 22 (4) ◽  
pp. 82-86
Author(s):  
S. I. Slukhay ◽  
K. P. Golovko ◽  
I. S. Drachev ◽  
D. V. Remizov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissues ◽  
Morphological Changes ◽  
Mechanical Damage ◽  
The Body ◽  
Acute Radiation ◽  
Weapons Of Mass Destruction ◽  
Internal Organs ◽  
Septic Complications ◽  
Experimental Animals

Experimental data on the course of the wound process and changes in the internal organs of animals during acute radiation sickness are presented. Morphological changes in the wound and with a fracture of the femur, on the model of combined radiation-mechanical conduction in 30 experimental animals (rats). It was found that wounds after primary surgical treatment often suppurate, and the performed osteosynthesis in fractures of tubular bones turns out to be an untenable delivery of metal structures. An unfavorable course of the wound process is noted in the form of pronounced purulent-necrotic changes in soft tissues, which leads to the appearance of degenerative-dystrophic changes in internal organs in experimental animals. The development of the infectious process in the wound, radiation damage is more severe, while the lethality increases by 2023%. The total area and thickness of the newly formed granulation tissue is 1,52 times less than in non-irradiated animals. As a consequence of the disturbance of reparative processes during the development of the mutual burdening syndrome, the consolidation of the fracture with radiation injury to rats was completed in 28,51,2 days, while in non-irradiated animals it was already by 2023 days. The reason for the death of animals is purulent-septic complications in 21 (73%) irradiated rats. Sepsis due to St. aureus was noted in 14 (66,6%) rats and St. epidermalis in 2 (9,5%) animals. Colibacillary sepsis was recorded in 5 (23,8%) rats. Thus, in the conditions of the use of weapons of mass destruction, radiation-mechanical damage will occupy one of the leading places in the structure of sanitary losses. At the same time, the simultaneous effect of radiation and a mechanical factor on the body forms one of the most dangerous variants of damage, in which a favorable outcome is predicted only in milder forms of acute radiation syndrome and provided that surgical treatment is timely.

scholarly journals Our experience with pediatric surgical treatment of fibular hemimelia

2020 ◽  
Vol 26 (4) ◽  
pp. 527-531
Author(s):  
A.M. Dzhuraev ◽  
◽  
B.U. Kholmatov ◽  
Kh.M. Karimov ◽  
A.R. Khashimov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Lower Limbs ◽  
Pediatric Orthopedics ◽  
Effective Treatment Option ◽  
Postoperative Rehabilitation ◽  
Fibular Hemimelia ◽  
Ankle Joints ◽  
Choice Of Treatment

Introduction Fibular hemimelia is a rare congenital malformation of lower limbs with associated deformities of the knee and ankle joints. There is no consensus among the authors regarding the choice of treatment method, appropriate timing of surgery, strategy and postoperative rehabilitation. Objective To explore clinical manifestations of the deformities and review outcomes of pediatric surgical treatment of fibular hemimelia. Material and methods Surgical treatment was performed for 11 children with fibular hemimelia at the Department of Pediatric Orthopedics, RSSPMCTO RUz between 2014 and 2019. Clinical and instrumentation studies were produced for all patients. Results Outcomes of surgical treatment were evaluated using functional characteristics with 7 rated as good and 4 as fair. Conclusion External fixation offers an effective treatment option in the pediatric surgical management of fibular hemimelia.

scholarly journals Surgical treatment of wounded persons with complicated thoracic damages

2020 ◽  
Vol 87 (11-12) ◽  
pp. 3-9
Author(s):  
Ya. L. Zarutskyi ◽  
S. A. Aslanyan ◽  
O. V. Borzykh ◽  
V. G. Hetman ◽  
V. E. Saphonov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Thoracic Trauma ◽  
Soft Tissues ◽  
Pleural Empyema ◽  
Main Group ◽  
Thoracic Wall ◽  
Vacuum Therapy ◽  
Medical Support ◽  
Gun Shot ◽  
Analysis Of Results

Objective. To improve the results of complex surgical treatment of wounded and injured persons with thoracic trauma, complicated by bronchopleural fistulas, pleural empyema and defects in the thoracic wall soft tissues, basing on introduction of the proposed procedure of vacuum therapy in combination with bronchoscopic obturation of certain bronchus. Materials and methods. Analysis of results of the complex surgical help delivery for 54 wounded persons with defects of the thoracic wall soft tissues, broncho-pleural fistulas and pleural empyema, caused by the combat thoracic trauma, on ІІІ and ІV levels of medical support while conduction of the Antiterrorist operation/Operation of the Joined Forces (the main group) and 73 injured persons with thoracic trauma of the peace period (the comparison group) in the 2014 - 2019 yrs period was conducted. Results. Improvement of complex surgical treatment of the wounded and damaged persons with thoracic trauma and defects of the thoracic wall soft tissues have permitted to reduce the complications frequency by 6.7%, and lethality - by 9.2% in the main group. Conclusion. There was proposed a procedure of vacuum therapy, ultrasound cavitation together with bronchoscopic bronchial obturation for its fistula, which have proved its efficacy in complex surgical treatment of severely wounded persons with the gun-shot thoracic damages and presence of combination of pleural empyema, bronchial fistula and defects of soft tissues.

scholarly journals Clinical Manifestations, Diagnosis and Treatment of Congenital Arthrogryposis in Children

2003 ◽  
Vol 10 (2) ◽  
pp. 79-85
Author(s):  
O L Malakhov ◽  
I S Kosov ◽  
I A But-Gusaim ◽  
S A Mikhaylova ◽  
O A Malakhov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
External Fixation ◽  
Clinical Manifestations ◽  
Treatment Method ◽  
Early Results ◽  
Fixation Devices ◽  
Therapeutic Exercises ◽  
Principles Of Treatment ◽  
Disturbance Detection

Experience in treatment of limb contractures and deformities in children with congenital arthrogryposis is presented. The main principles of treatment were detected. Complex of diagnostic and curative measures including conservative treatment of patients stating from birth is described in details. Conservative treatment consists of therapeutic exercises, massage, physiotherapy, special braces and plaster bandages. Surgical treatment method using external fixation devices is presented. The method of biocontrol disturbance detection is given and the use of functional biocontrol (FBC) method for the treatment of this pathology is well grounded. Early results of FBC use are evaluated as positive ones that confirms the expedience of further use of FBC for the treatment of patients with congenital arthrogryposis.

Sign in / Sign up

Export Citation Format

Share Document