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Model of passing a bullet 5.45x39 V-max through a block of ballistic plasticine, t=0.0002 s: A-deformation, B -equivalent strain (inlet), C -equivalent stress (cut), D -equivalent strain (surface, which describes the volume of tissues affected by the kinetic energy of the bullet)
Source publication
Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conduct...
Context in source publication
Context 1
... simulation of the damaging effect of the 5.45 mm V-max expansive bullet 0.0002 s after the shot is shown in Figure 7. To compare the severity of the wound between the expansive and ordinary bullets, the value of the equivalent strain acting on the walls of the wound canal is shown in Figure 8. ...
Citations
... The latter is associated with a high rate of lethal outcomes and longer rehabilitation in those, who survived due to injuries of multiple organs and major vessels of the chest and abdomen, bone fractures as well as severe maxillofacial trauma [9][10][11][12]. The modern weapon is designed to cause critical and severe damage in multiple organs which is presented by separate injuries to the chest or abdomen, or combined trauma, including abdominal and thoracoabdominal cases [1,5,6,13,14]. ...
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.
... Since then, different types of injuries have been described, and these injuries were associated with application of the high-energy weapons such as multiple-launch rocket systems, cruise missiles, or autonomous pusher-prop drones by the aggressor [2][3][4][5]. Severe injuries could be seen with various presentations, with frequent atypical or unusual clinical courses, which might be related to the bullet type as shown in experimental studies [6,7]. Severe trauma cases were described for the genitourinary, abdomen, vascular structures, chest, and neck as well as for the extremities in war in Ukraine [2][3][4][5]8]. ...
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.
Background. The purpose is to determine the place and role of oblique projections in the analysis of multislice computed tomography (MSCT) data in gunshot wounds. Materials and methods. More than 3,300 MSCT studies performed in wounded and traumatized patients over a certain period in the Military Medical Clinical Center of the Northern Region of the Medical Forces Command were prospectively studied. All the wounded were male, the average age was 42.1 ± 2.4 years. MSCT of the head, thoracic and abdominal organs, pelvis, and limbs was performed. The frequency of using oblique projections and their informativeness were studied. Results. A prospective study demonstrated that coronal, axial, sagittal projections, and 3D modeling were used in 100 % of cases, and in 21.4 % — oblique projections to improve MSCT results. The distribution by localization of MSCT was as follows: head — 32.9 %, neck — 7.6 %, chest organs — 32.2 %, abdominal organs — 22.3 %, limbs — 5.0 %. MSCT in angiomode was performed in 3.5 % of injured and traumatized patients: head — 27.2 %, neck — 18.4 %, chest organs — 28.9 %, abdominal organs — 23.7 %, limbs — 1.8 %. Oblique projections in MSCT data analysis were used when studying the wound channel in 82.3 % of cases, to improve the visualization of vessels during MSCT in angiomode — in 12.6 % and to improve the visualization of bone fracture lines — in 5.1 %. Conclusions. In the structure of MSCT studies, the head, thoracic organs, abdominal organs, neck, and limbs prevail by localization (in descending order). Oblique projections are used is 1/5 of cases and allow to improve the visualization of the direction of the wound channel, vessels during angiography and lines of flat and long tubular bone fractures.
