ABSTRACT
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.
Subject(s)
Abdominal Injuries , Laparoscopy , Thoracic Injuries , Thoracic Surgery, Video-Assisted , Wounds, Gunshot , Humans , Wounds, Gunshot/surgery , Ukraine , Male , Adult , Thoracic Injuries/surgery , Thoracic Injuries/diagnosis , Thoracic Surgery, Video-Assisted/methods , Laparoscopy/methods , Abdominal Injuries/surgery , Abdominal Injuries/diagnosis , Hospitals, Military , Young Adult , Treatment Outcome , Retrospective Studies , Laparotomy/methodsABSTRACT
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.
