Rapid rehabilitation and restoration of the function of damaged anatomical areas in the military is the main goal of military medicine. In the case of gunshot wounds of the knee joint with defects of ...soft tissues, one of the optional methods of reconstructive and plastic "closure" is the usage of a propeller flap. The clinical case represents a mine-explosive wound of the lower extremities with a defect of the soft tissues of the lateral aspect of the right knee joint in a serviceman of the Ukrainian Armed Forces as a result of artillery shelling in the east of Ukraine in November 2022. There was an isolated shrapnel tangential non-penetrating wound on the lateral aspect of the right knee joint with a soft tissue defect measuring 7.2x3.2-1.0 cm. The aim of the work was to study the thermographic and sonographic features of soft tissue perfusion after gunshot injuries of the lower extremities and on the basis of the temperature dynamics data from the wound surface in combination with the sonographic examination of the vessels to determine the rationality and relevance in the reconstruction of defects of the lower extremities by propeller tactics. Reconstruction with flap with a perforating vessel as the "key" of LSGA (lateral superior genicular artery) and a dynamic multimodal concept (DMT) with the use of audio doppler in the pre-, intra- and postoperative period) with closure of the defect due to a rotary perforating flap with supplying was carried out. During the entire period of treatment, of the injured the temperature background from the surface of the flap was followed up using FLIR C2, and sonographic changes in blood flow were monitored in the projection of the LSGA location. We came to the conclusion that applying the technique of flaps on perforating vessels, several goals are tactically achieved: restoration of the completeness and function of the damaged area, reduction of complications in the recipient and donor areas. Thus, the propeller flap can be classified as a primary option for "replacemen t" of tissues among the restorative tactics of the damaged area of the lower extremities caused by a gunshot origin.
There was made the analysis of wound ballistics of modern expansive bullets in comparison with shell bullets on 25 blocks of ballistic plasticine (ROMA PLASTILINA No. 1, Ballistic Testing Backing ...Material), made in the USA, in which one shot from an AKS-74 automatic firearm and carbine ZBROYAR Z-10 with an optical sight was fired. The bullet speed was the highest in 5.45x39 caliber cartridge with a V-max bullet. – 1185 m/s, low in the bullet caliber cartridge .308 Win with a bullet SP, – 664 m/s. The difference is significant at the level of significance α=0.05. In terms of the size of the entrance hole, the largest is from the bullet of cartridge .308 Win with a bullet SP – 10.0 cm, the smallest - from the bullet "PS" with a steel core 5.45x39 mm, cartridge sample of the year 1974 (7H6) – 1.2 cm. The difference is significant at the level of significance α=0.05. In the expansive bullet of type "V-Max" of shortgun cartridge of caliber 5.45x39 mm, the size of the entrance hole was 9.1 cm, with asterial shape having radial gaps and turned edges of ballistic plasticine on the outside. All cartridges with expansive bullets did not have an exit hole after the shot. The dimensions of the formed residual cavity were the largest after firing with .308 Win caliber cartridge with a bullet SP – 25.0x5.0 cm., the smallest – bullet of a military caliber cartridge of 5.45x39 mm (7H6) – 6.0x4.0 cm. The difference is significant at significance level α=0.05. The shape and character of the residual cavity in ballistic plasticine was significant for all expansive bullets, in contrast to the bullet of a military cartridge 5.45x39 mm (7H6), where no such changes are detected. The considerable signs of expansion properties and deformation of the bullet in the form of a "flower of death" were identified in the bullet of caliber cartridge .308 Win with a bullet SP, other bullets with expansive properties showed significant fragmentation, with the location of fragments both in the residual cavity and outside its borders at different distances. Expansive bullets differ significantly at the level of significance α=0.05. The low flight speed of bullets (m/s) of .308 Win caliber cartridges with bullets BTHP and SP is due to their structure, weight, and caliber. Bullet of type V-max with cartridge 5.45x39 mm has the highest speed – 1185 m/s, and due to its design has significant expansive properties. Common to expansive bullets is a entrance hole, the blind nature of the lesion with the presence of a large residual cavity, which is due to kinetic energy return 114.37 E, J/mm2 inside the object of lesion. Fragmentation of expansion bullets occurs inside an object with fragments located at different distances. A .308 Win caliber cartridge with SP bullet causes deformation of s bullet by the type of "death flower" causing significant damage.
Gunshot wounds to the chest have always occupied a special place among the entire set of gunshot wounds on the human body. Today, the one of the important challenges before the Navy of the Armed ...Forces of Ukraine, - not only to restore the damaged anatomical structures of the chest, but also to create optimal conditions for the restoration of the functional component. This will make possible to reduce the treatment period of a wounded serviceman and return him to the formation (or to the occupied position) as soon as possible. The use of minimally invasive methods (videothoracoscopy, radiation control and magnetic technologies) during the treatment of a wounded person with a penetrating gunshot wound of the chest is the key in the surgeon’s hands whose task is to save life and eliminate the defect (formed as a result of the wound). This approach is not only an example of highly specialised surgical care for the wounded in the navy, but also demonstrates the high quality of the proposed care scheme. Purpose - practically implement new organisational, tactical and professional approaches to the treatment of gunshot wounds to the thorax using a clinical case study. It is presented the clinical case of wounded man Sh., 35 years old, with a gunshot fragmentation blind wound of the posterior surface of the thorax, gunshot fracture of the Th7 vertebral body on the background of a foreign body (metal arrowhead). In the current world literature, there are many options for surgical tactics for the treatment of wounded patients with penetrating gunshot wounds to the chest. However, our clinical case draws attention to the high relevance of applying and combining minimally invasive techniques (video-othoracoscopy, radiation control and magnetic technology). This makes it possible to reduce the time (or duration) of surgical intervention, perform an «extended» revision of the pleural cavity, examine and assess the condition of the wound canal, remove a foreign body (shrapnel, bullets, arrowhead component), compensate for respiratory failure phenomena as quickly as possible and restore the integrity and function of the thoracic cells. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
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.
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.
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.
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.
•The laryngopharynx wound is considered to be one of the most severe wounds of neck.•The most consistent with the specified criteria for myoplasty in this area is myoplasty using the sternocleidomastoid muscle.•The case described by us with the use of ladder myoplasty is presented for the first time in Ukraine.•The proposed method of ladder myoplasty using the sternocleidomastoid muscle is unique, has shown its high efficiency.
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 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.
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