Abstract:
According connection with the global trends, manifested by an increase in the
number of illegal firearms, an increase in social, political, ethnic, racial and
religious conflicts, accompanied by the use of firearms, the problem of treating
gunshot wounds is becoming increasingly important. It is especially acute
during local and widespread hostilities, during peacekeeping missions, antiterrorist operations, in cases of massive gunshot wounds.
The aim of the work is to improve the surgical tactics in the reconstruction of
severe wounded with soft tissue gunshot defects due to the multimodal scheme.
Improvement of dynamic audio and thermal imaging diagnostics of the damaged
anatomical area, analysis and modeling of the shape and direction of movement
of the donor flap. A clinical case of closure of a bullet-through bullet wound of
the left thigh (03.25.19 year) with a gunshot multi-fragment fracture of the left
femoral pigtail in the middle third, damage to the superficial femoral vein and
marginal damage to the superficial femoral artery was demonstrated.
In the preoperative period, the first stage was dynamic digital thermography of the surface of wounds and
surrounding soft tissues, which allowed thermal imaging to assess the state of damaged structures, to identify areas
of preservation of blood supply. The second stage was the audio control of the identified areas of the "supply" -
perforating vessels with a comparison of the blood flow velocity. The results obtained formed the basis for
modeling the donor zone and monitoring its movement. The described clinical case of soft tissue defect closure
consisted of three stages:
The first stage - preparatory (diagnostics and cleaning) - (9 days of inpatient treatment) - repeated surgical
treatment of wounds using low-frequency ultrasound (cavitation of the wound surface), controlled negative
pressure (in a pulsed mode - 125 mm Hg), the imposition of secondary early sutures, due to which the wound area
decreased by 35% compared to the wound area at the time of admission to the VICC of the Southern region.
The second stage - the final (reconstructive) - (12 days after the injury) - plastic reconstruction of the defect of the
posterior surface of the middle third of the left thigh by moving a ball-and-socket flap from the outer surface of the
thigh using the Keystone technique.
Conclusions: A multimodal algorithm with dynamic control of changes in the perfusion of the defect zone and
surrounding structures is at the heart of the successful reconstruction of a gunshot defect in the soft tissues of the
lower extremities, which reduces the treatment time by 1.5 times.
