Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine.

The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0-3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions.

Spontaneous longitudinal rupture of the thyroid cartilage: A management of the rare clinical case.

INTRODUCTION AND IMPORTANCE: Non-traumatic rupture or other injuries to the larynx are very rare disorder. According to the published series, there are only 15 cases reported with such kind of injury to the larynx. Despite the rarity of the non-traumatic larynx fracture, it is important to elucidate adequate management for the patients with such emergency. The aim of the study is to demonstrate the features of clinical manifestations, examination, and surgical treatment of a case of spontaneous longitudinal rupture of the thyroid cartilage. PRESENTATION OF CASE: A 54-year-old male patient presented with chief complaints of pain in the front surface of the neck, difficulty swallowing and breathing during physical exertion, hyperemia of the skin on the front surface of the neck, and the presence of subcutaneous emphysema. 20 h after the onset of the symptoms, the patient reported breathing difficulties that appeared during physical exertion, and the patient walked to the hospital. Computed tomography revealed a longitudinal rupture of the thyroid cartilage, emphysema of the neck, and the presence of air in the anterior-upper mediastinum. The defect of the ruptured thyroid cartilage was treated by suturing as well as by myoplasty using sternocleidomastoid muscle. CLINICAL DISCUSSION: Our case report is in line with others, showing that patient with spontaneous rupture of the thyroid cartilage is the surgical emergency. Our approach of using myoplasty was not presented before. CONCLUSION: This case report adds evidence and knowledge about such rare disorders as spontaneous rupture the thyroid cartilage rupture. It is useful to apply the technique of myoplasty with sternocleidomastoid muscle flaps, ensuring reliable sealing of the damaged area reducing the risk of failure, and inflammatory complications, and supporting neck functions in the postoperative period.

A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the Russo-Ukrainian war.

BACKGROUND: Gunshot injury to the hand is severe trauma, requiring complicated reconstruction surgery for the damaged anatomic site to restore all the hand functions. The aim of this study was to show the example of the distal phalanx reconstruction by using a flap with distal transverse digital artery (DTDA) blood supply as well as to demonstrate the utility of the audio Doppler application at the reconstruction stage in the combat patient injured in the Russo-Ukrainian war. CASE PRESENTATION: In this report, we present a case of a 26-year-old service member of the Ukrainian Armed Forces delivered to the Military Medical Clinical Centre on the fourth day after the gunshot gutter shrapnel wound of the distal flexor of the 2nd digit with a gunshot fracture of the ungula (distal) and middle phalanges of the 2nd digit of the right hand along with a bone deficiency of the osseous structure of the distal and middle phalanges, volar soft tissues. The dorsal metacarpal artery (DMCA) flap is a universal variant among the tools of the reconstructive plastic surgeon engaged in reconstructing defects of the digital dorsum and flexors with a limited range of flaps. We consider this to be a key that conforms with the majority of the reconstructive principles, such as 'analog replacement', and which is simple, adequate, and easy for operating with a minimal sequela of the donor site. CONCLUSIONS: The distal transverse digital artery (DTDA) could be considered for hand reconstructive surgery for repairing defects of the flexor surface of the digit injury and hands after severe gunshot injury.

GUNSHOT SHRAPNEL WOUND OF THE THIGH WITH DAMAGE TO THE SUPERFICIAL FEMORAL ARTERY (FEATURES OF CLINICAL MANIFESTATIONS, DEVELOPMENT OF COMPLICATIONS WITH LATE MEDICAL CARE AND PRESERVATION OF THE LIMB).

OBJECTIVE: The aim: To demonstrate the features of clinical manifestations and complications that occur with delayed medical treatment in cases of gunshot shrapnel through a wound of the thigh with damage to the superficial femoral artery. PATIENTS AND METHODS: Materials and methods: The wounded individual, S., was 52 years old and had sustained a gunshot wound through a shrapnel wound of the left thigh with damage to the superficial femoral artery and soft tissue defect. Medical assistance was provided during the stages of medical evacuation. RESULTS: Results: The soldier sustained a gunshot wound through the upper third of the left thigh, resulting in damage to the vascular-nerve bundle and a soft tissue defect. First aid was provided at the scene, and surgical procedures were performed during the stages of medical evacuation, including primary surgical treatment of wounds in the upper third of the left thigh. On the second day following the injury, the wounded man was transferred to the Vinnytsia Military Medical Clinical Center and admitted to the vascular surgery department. After an ultrasound examination and repeated surgical treatment of the wound on the left thigh, damage to the superficial femoral artery was identified. CONCLUSION: Conclusions: The presence of features of blood circulation in gunshot wounds of the main vessels of the lower limbs can favorably affect the possibility of saving the limb, as evidenced by the case presented.

PROSPECTS OF THE HIGH-SPEED MULTIMEDIA DATA TRANSMISSION TECHNOLOGIES USE IN THE STRUCTURE OF THE SYSTEM FOR PROVIDING AID TO INJURED PERSONS HAVING A GUNSHOT DEFECT OF SOFT TISSUES.

OBJECTIVE: The aim: To improve the results of providing medical care in the conditions of a full-scale war in Ukraine due to the use of medical technologies. PATIENTS AND METHODS: Materials and methods: From the first days, the Military Medical Clinical Center of the Southern Region provided medical assistance to the persons wounded as a result of the Russian Federation's armed aggression. The presented multidisciplinary observation includes data received from 24.02.22 to 26.05.22. During this term, the multidisciplinary team assisted by the Teladoc Health system (the connection between the Charite Clinic, Berlin, and the MMCC of the Southern Region, Ukraine) performed 39 reconstructive and remedial operations in the MMCC of the Southern Region (Department of Surgical Infection). RESULTS: Results: It has been found that the implementation of differentiated surgical tactics (developed in cooperation between Charite clinics, Berlin, and MMCC of the Southern Region, Ukraine, using the Teladoc health system) in wounded patients with gunshot defects of soft tissues at the III and IV levels of medical care improves functional results, increases indicators of satisfactory from 46.9 % to 53.7 %, reducing the relative number of unsatisfactory from 18.8 % to 11.6 %. CONCLUSION: Conclusions: The information exchange in the Teladoc Health system is performed in telephone mode through protected communication channels. It enabled real-time treatment strategy recommendations and improved functional outcomes, increasing the satisfactory rate from 46.9 % to 53.7 %, and reducing the relative unsatisfactory rate from 18.8 % to 11.6 %.

Surgical tactics in fire kidney injury and the first experience in performing laparoscopic nephrectomy at the II level of medical support (role II) in combat conditions: Case report.

INTRODUCTION AND IMPORTANCE: According to the data from the American Urological Association (AUA) and the European Urological Association (EAU) (2020), kidney is the most frequently damaged organ of the genitourinary system. Kidney damage occurs in approximately 5 % of injured people and accounts for 24 % of traumatic injuries to abdominal organs. Surgical treatment remains the gold standard in unstable patients with gunshot and stab wounds. Minimally invasive surgical treatment of kidney injuries, which is usually performed after laparoscopic diagnosis, at the II level of medical care becomes possible in the first hours after injury. CASE PRESENTATION: We performed two laparoscopic nephrectomies caused by gunshot shrapnel damage to the kidney in a military mobile hospital at the II level of medical support. The time since the injury was 64 ± 16 min. The wounded were extubated after the operations, activated on the first day. In one case, the drain was removed on the third day, in the other - on the fourth day. During the monitored period (30 days) after the operation, there were no complications in both wounded. CLINICAL DISCUSSION: Laparoscopic nephrectomy in gunshot damage to the kidney was characterized by presence of a retroperitoneal tense hematoma. When opened, there were signs of bleeding from the kidney parenchyma, difficulty of anatomical visualization of anatomical structures - ureter, renal artery and vein. CONCLUSION: It is possible to perform endovideosurgical operations - laparoscopic nephrectomy in combat kidney injury at a military mobile hospital with available high-tech equipment at the II level of medical support (Role II), thus bringing highly specialized care closer to the wounded. We noted a better cosmetic effect after the laparoscopic operations.