Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of ...russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds.
The problem of gunshot wounds treatment is one of the urgent and incompletely resolved issues of modern surgery. Diagnosis of gunshot wounds is currently not efficient enough. There was a need to ...improve the content and scope of medical care with the possibility of strengthening its diagnostic chain. The aim of the work is to substantiate experimentally the feasibility and effectiveness of using diagnostic infrared thermometry in gunshot wounds of the soft tissues of the extremities. Experimental studies were performed under the chronic experimental conditions on Shinshilla breed rabbits which were subjected to gunshot wounds followed by laboratory, morphological and functional examination for 5 days. The animals were divided into 3 groups depending on the type of gunshot wound that was inflicted. The animals were removed from the experiment by the introduction of chloroethyl anesthesia on the 1st, 3rd and 5th days, after which the soft tissues with the capsule surrounding the fragment were subjected to histological and electron microscopic examination. On the 1st day of the study, a significant decrease in the diameter of the blood vessels of the affected area was determined in the group of animals that were subject to injury with firearms and metal fragments from the explosion of a grenade and an improvised explosive device. It was in these groups that the highest mortality rate was registered. Under the specified conditions of injury to the limbs of animals, as well as when injured by a pneumatic weapon with a temperature of fragments of 100 oC, pronounced changes in pulse and respiratory rate were noted. In further studies on rabbits on the 3rd and 5th days of the experiment, the actual results did not differ from those obtained 24 hrs after injury. Those rabbits that survived after the reproduction of various gunshot wounds had the greatest value. The results of their thermometric measurements were evaluated in the dynamics of experimental gunshot wounds and revealed the dependence of animal survival after gunshot wounds on the temperature of the limb in the area of the wound.
There are the following leading criteria in favor of animals further survival after gunshot wounds - the presence of a perforating vessel in the area surrounding the affected space; the size of the diameter of the vessels in the adjacent area; no hemorrhage in the muscle tissue located near the affected area; comparable with normal data of the functional parameters of the animal's body – heart rate, blood oxygen pressure and respiration; thermometry results. The limb thermometry has the important prognostic value after their gunshot wound in terms of experimental animals survival. The correspondence of high thermometry indexes after a gunshot wound vs the higher risk of an animal death is statistically reliable and, accordingly, insignificant thermometric dynamics throughout the experiment is in favor of a positive outcome after injury. It is extremely important to evaluate thermometry data during the first 24 hours after receiving gunshot wounds, since we found out the maximum validity of this method in the early time intervals. All this, with adequate clinical testing and verification, has the most important medical prospects, aimed primarily at saving time for diagnostic measures and procedures. Thermometry allows to judge the activity and severity of connective tissue inflammation or sclerosis in the lesions of each wound and provides the possibility of clinical application of remote thermography as a non-invasive method of diagnosis and prediction of complications in wounded with gunshot and explosives in various wounds.
Purpose – analysis and generalization of the experience of the National Academy of Medical Sciences (NAMS) of Ukraine and its subordinate research institutions, with clinical units in their ...structure, on the provision of highly specialized medical care to the wounded, injured, injured and sick servicemen during the anti-terrorist operation and the operation of the Joint Forces (ATO/JFO), as well as the civilian population and internally displaced persons from the temporarily occupied territories. The object of the research is the health care system of military personnel.The subject of the research is the work of the National Academy of Medical Sciences of Ukraine on the organization and provision of medical assistance to military personnel and civilians during the ATO/JFO.Research methods: bibliographic, statistical, analytical, systems approach. The NAMS of Ukraine and its subordinate research institutions, with clinical units in the structure, during the ATO/JFO took an active part in the provision of medical care to the wounded, injured, injured and sick servicemen of the Armed Forces of Ukraine and other military formations. The work of the NAMS of Ukraine in providing medical assistance to servicemen was multi-vector and was carried out in several directions: organizational, direct provision of medical care and its scientific support. Clinical institutions of the NAMS of Ukraine during the ATO/JFO did not stop providing highly specialized medical care to the civilian population of Ukraine, including internally displaced persons from the areas of the ATO/JFO. Thanks to the coordinated activities of the Presidium of the NAMS of Ukraine and its subordinate research institutions, a significant contribution has been made to the provision of highly specialized medical care to the wounded, injured and sick servicemen, as well as internally displaced persons from the temporarily occupied territories.
Мета. Оцінити можливості ультрасонографії у діагностиці характеру ушкоджень м'яких тканин кінцівок при вогнепальних пораненнях. Матеріали та методи. Проведено аналіз результатів комплексної ...ультрасонографії у діагностиці характеру ушкоджень м'яких тканин кінцівок у 147 пацієнтів з різними видами вогнепальних поранень. Вік пацієнтів варіював у межах 28-49 років, у середньому 31±6 років. Результати. Вогнепальні поранення нижніх кінцівок з єдиною локалізацією реєструвалися у 109 (74,2%), з множинною локалізацією - у 38 (25,8%) поранених. Загальна кількість вогнепальних поранень гомілки становила 83 (42,8%), стегна – 76 (39,2%), ступні – 35 (18,0%). Балістичні поранення були у 49 (25,3%) випадках, осколкові поранення – у 124 (63,9%) та мінно-вибухові – у 21 (10,8%) випадку. Ураження нервів спостерігалося у 42 (21,6%) випадках, судин – у 49 (25,3%) та інших м'яких тканин – у 103 (53,1%) випадках. Тромбоз великої підшкірної вени реєструвався в 4, поверхневої стегнової вени – у 5, литкової вени – у 7, підколінної вени – у 8 випадках. Висновки. Ультрасонографія з доплерографією може використовуватися як основний метод діагностики вогнепальних ушкоджень м'яких тканин кінцівок, зокрема магістральних судин та периферичних нервів.
Мета роботи – дослідження місця та ролі Національної академії медичних наук (НАМН) України та підпорядкованих їй науково-дослідних установ, в структурі яких є клінічні підрозділи, в системі надання ...медичної допомоги пораненим, ураженим, травмованим і хворим військовослужбовцям під час антитерористичної операції та операції Об’єднаних сил (АТО/ООС).
Матеріали та методи. Використано нормативно-правові акти з питань національної безпеки держави та охорони здоров’я в Україні, публікації у відкритих наукових джерелах стосовно діяльності Національної академії медичних наук України в цілях надання медичної допомоги військовослужбовцям під час АТО/ООС. Методи дослідження – бібліографічний, статистичний, аналітичний, системного підходу.
Результати. НАМН України та підпорядковані їй науково-дослідні установи, в структурі яких є клінічні підрозділи, під час АТО/ООС взяли активну участь у наданні медичної допомоги пораненим, ураженим, травмованим і хворим військовослужбовцям ЗС України та інших військових формувань. Робота НАМН України щодо надання медичної допомоги військовослужбовцям була багатовекторною і велася за декількома напрямами: організаційний, безпосереднього надання медичної допомоги та наукового супроводу. Клінічні установи НАМН України під час АТО/ООС не припиняли надання високоспеціалізованої медичної допомоги цивільному населенню України, зокрема й вимушеним переселенцям з районів проведення АТО/ООС.
Висновки. Завдяки злагодженій діяльності Президії НАМН України та підпорядкованих їй науково-дослідних установ зроблено вагомий внесок у надання високоспеціалізованої медичної допомоги пораненим, ураженим травмованим і хворим військовослужбовцям під час АТО/ООС, а також сформовано основні напрями розвитку вітчизняної військово-медичної науки: організаційний, лікувально-профілактичний та логістично-технологічний.
Introduction. The experience of providing medical care during the Anti-terrorist operation in eastern Ukraine showed that in the structure of modern combat surgical trauma gunshot wounds with soft ...tissue defects are between 64.9-68.2%, of which 36.4-37.5% are small and medium, 28.5-30.7% are large and very large defects.Aim: To improve the results of providing surgical care to the wounded with soft tissue defects by introducing a variety of surgical tactics of wound closure to the medical care levels.Material and Methods. The total array of the study was 2537 wounded with shrapnel, bullet and mine injuries from April 2014 to September 2018. The determination of surgical tactics for closing soft tissue defects was performed at the basis of metric classification taking into account the area, volume and anatomical areas of the lesion.Results. The combination of metric characteristics of wound defects by area, volume with localization of wounds in a single classification allowed the offer of a comprehensive approach to sorting the wounded at the level of medical care and to determine further surgical tactics to close soft tissue defects. In accordance with the sorting and evacuation purposes, the wounded with gunshot wounds to the foot and hand (third zone of injury) were treated in specialised centres to the fourth level of medical care. In the case of medium and large wounds of the thigh, leg, shoulder and forearm, medical care was provided at the second and third levels. And in the case of large and very large wounds of the specified localisation was provided in specialised clinics of the fourth level.Conclusions. The introduction of differentiated surgical tactics in the wounded with soft tissue defects at the levels of medical care has improved functional results: increase the proportion of good from 46.9% to 53.7%, reduce the relative number of unsatisfactory from 18.8% to 11, 6%.
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