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 %.