Substitute ellipse of the permanent cavity in gelatin blocks and debridement of gunshot wounds.

A new method in terminal ballistics is presented that allows precise numerical analysis of characteristics of the permanent cavity by computed tomography (CT). Shots were made with a Russian AK-74 assault rifle (5.45 mm) into gelatin used as a tissue simulant. CT scans were made of the gelatin blocks, transferred into digital format, and analyzed using computer software. CT scans of the permanent cavity are characterized by markedly irregular shapes, and an attempt was made to simplify these forms and to link them with surgical debridement of gunshot wounds. An assumption was made that the zone of debridement has the form of an ellipse. Using the information from the CT images, a substitute ellipse was constructed as an approximation of the a vital tissue surrounding the wound channel with the aim of approaching a more exact definition of the zone of necessary debridement of gunshot wounds.

Terminal ballistics of the Russian AK 74 assault rifle: two wounded patients and experimental findings.

OBJECTIVE: To study the effects of the Russian AK 74 assault rifle missile (5.45 x 39 mm) on an experimental model and on two wounded patients. DESIGN: Experimental and clinical study. SETTING: Brodarski Institute, Marine Research and Special Technologies, Zagreb, Croatia, and General Hospital, Karlovac, Karlovac, Croatia. MATERIALS AND PATIENTS: Twenty gelatin blocks used as tissue stimulants and two patients with gunshot wounds caused by AK 74 assault rifle missiles. INTERVENTIONS: After being fired at, gelatin blocks were filmed with a high-speed television camera and radiographs were made of the blocks. Wounds of our patients were treated with minimal excision and drainage. MAIN OUTCOME MEASURES: The correlation between the wound profile method and our experimental model, and the correlation between the wound profile method and the wounds of the patients we treated. RESULTS: Bullets were not found to deform or fragment in tissue stimulant. The bullet path through the gelatin block was found to differ from the path predicted according to the wound profile method. CONCLUSION: Gelatin disruption in the initial 8 to 11 cm of the bullet path is minimal. Even the highest-velocity military missiles, like the AK 74 5.45 x 39 mm bullet, may cause only minimal tissue disruption in this initial part of tissue penetration.

Initial throw locking internal knotting technique.

Internal knotting is a highly versatile technique that closely resembles classic suturing. However, most intracorporeal knots are cumbersome and require a long time to master. We describe a simple, easy, and safe method for internal knotting that can also be used in open procedures and practiced until mastery is achieved. With this technique, the initial throw will never fail to hold tissues in apposition until the whole knot is constructed. The completed knot combines the maximum in suture support with a minimum of foreign body reactivity.

Multiple injuries in peacetime and wartime estimate of severity of injury by the Injury Severity Score and Polytraumaschlüssel.

OBJECTIVE: To compare the Injury Severity Score (ISS) and Polytraumaschlüssel (PTS) in patients with multiple peacetime and wartime injuries. DESIGN: Prospective and retrospective study. SETTING: General hospital, Croatia. SUBJECTS: 71 patients with multiple injuries admitted between 1 January 1993 and 30 September 1994; 41 had peacetime (road traffic accident) injuries and 30 had been injured in battle. INTERVENTIONS: ISS and PTS scores. MAIN OUTCOME MEASURE: Correlation of scores with morbidity and mortality. RESULTS: All patients with wartime injuries were men, compared with 30/41 (73%) of those with peacetime injuries (p < 0.0001). Those with wartime injuries were slightly but not significant younger (mean 35 years, range 17-69, compared with 44 years, range 17-87). Mortality was higher among those with peacetime injuries, but not significantly so (11/41 compared with 5/30, p=0.39). The two scores correlated well for all injuries (r=0.76), and peacetime (r=0.71) and wartime injuries (r=0.84) separately (all correlations p < 0.0001). In both groups, patients who subsequently died scored significantly higher with both scores (p < 0.001). CONCLUSIONS: The two scores were equally good at describing the severity of injury, and the likelihood of subsequent death, however the injuries were caused.

An infected wound in a patient with necrotising fasciitis.

This case study describes the management of a patient with rheumatoid arthritis and diabetes mellitus who presented with necrotising fasciitis.

Methods and results of the treatment of peacetime and wartime multiple injuries--a comparative study.

Seventy-one patients suffering from multiple injuries were divided into two groups, according to the manner in which the injuries were inflicted. Forty-one were injured in 'peacetime' circumstances (road traffic accidents, 85.4 per cent), and 30 patients were injured during 'military' shelling or in combat. Since there is no generally accepted severity scoring of wartime multiple injuries, this paper has offered one. A 'peacetime' scoring system was used to compare the hospital mortality in the two groups. The severity of injuries in both groups was estimated by using the Injury Severity Score. There was no statistically significant difference between the two groups with regard to injury severity, age, hospital mortality rate, received infusion, or the number of specialists involved in treatment. The differences between the two groups were significant in the application of transfusion and antibiotics, number of operations performed, and the time span between injury and operation.

Hydraulic optimalization of surgical flow drainage in physical model.

In the present study, the flow in deep, closed wound with various types and position of drain was studied. A physical model of regular geometrical wound was designed to investigate the events occurring in the wound from the standpoint of hydraulics. Results of the study showed that the commonly used method of drain application could be improved. The results may also prove helpful for improvement of the existing drains and their more favorable positioning.

[Mathematical model of hydrodynamic flow in irrigation-suction drainage]. / Mathematisches Modell von Strömungsverhältnissen bei Spül-Saug-Drainagen.

The aim of this study was to evaluate the flow of fluid between closed drains in deep wounds and osteomyelitic and abscess cavities. For the purposes of this study we created a numerical wound model. This model had a symmetric geometrical shape and we simulated flow of fluid between the drains in four variants of distance between these drains. The results of this model showed that the distance often used between drains in clinical practice is not effective. Better drainage could be achieved by spacing the drains more. These results can be used for more functional and better drainage if drains are placed properly in osteomyelitic or wound cavities.

Effects of ozone on how well split-thickness skin grafts according to Thiersch take in war wounds. Results of prospective study.

In a prospective study on 35 wounded persons we examined the effects of ozone on how well split-thickness skin grafts took in war wounds. Each of the 35 wounded persons hat at least two similar gunshot wounds, one on the lower leg or forearm and the other on the upper leg or upper arm. During the first 10 days all wounds were treated with 10% NaCl water solution dressings until the moment when healthy granulations were observed. Thereafter, the defects were covered with split-thickness skin grafts according to Thiersch. For technical reasons we treated grafts on the lower leg and forearm with ozone following the usual scheme. Grafts on the upper leg or upper arm were treated in the conventional way and they served as a control group. The results obtained in the group followed up are presented by percentage of graft takes after 10 days and accordingly compared with the results obtained in the control group. There was a higher percentage of takes in ozone-treated split-thickness skin grafts. More than 74.3% of the split-thickness skin grafts treated with ozone had a take of more than 75% of the covered surface as apposed to only 40% of the grafts treated with the conventional method. The results in these two groups were compared with a chi square matched pair test. Difference in take of the skin grafts in these two groups was statistically significant at P < 0.01.

[Embolization therapy of a femoral hemangiolipoma with intra-osseous invasion]. / Embolisationstherapie eines Oberschenkelhämangiolipoms mit intraossaler Ausdehnung.

The paper presents the case of a gigantic inoperable hemangiolipoma of the right upper leg with infiltration into femur. Performed embolization therapy resulted in satisfactory subjective and objective improvement.

[The preventive and therapeutic effect of peracetic acid on the development of surgical infection]. / Profilakticko i terapijsko djelovanje peroksioctene kiseline na razvoj kirurske infekcije.

The paper reports on the possibility of application of peracetic acid on live tissue by correcting those properties which presented the obstruction for its former application on live tissue. Using laboratory technique the degree of peracetic acid acidity was put to pH 5 and the concentration of 0.2% was determined by testing in vitro on the resistant hospital strains of Staphylococcus aureus and Pseudomonas aeruginosa. The prophylactic and therapeutic activity on artificially induced infection of wounds by above mentioned bacteria was investigated in experiments (rabbits n = 30). The prophylactic and therapeutical efficacy of peracetic acid of certain properties was proved by comparing it with the control group of wounds where physiological solution was used as a compress.

[Structural analysis of external fixators of bones and the anatomy of the olecranon process]. / Strukturalne analize vanjskih fiksatora kostiju i anatomske kukaste plocice za olecranon.

Shown is the structural analysis of the broken bone metal fixator and of the anatomic hooked metal sheet for olecranon, from the structural engineering point of view. The FE models are structurally examined using the ICES STRUDL system and the COMPUTERVISION for graphics simulations.