Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions
ARTICLE PDF (Українська)

Keywords

gunshot wound; upper extremity; results; tactics; prognosis; treatment.

How to Cite

Strafun, S., Kurinnyi, I., Borzykh, N., Tsymbaliuk, Y., & Shypunov, V. (2021). Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions. Herald of Orthopaedics, Traumatology and Prosthetics, (2(109), 10-17. https://doi.org/10.37647/0132-2486-2021-109-2-10-17

Abstract

Summary. Our study aimed to optimize the tactics of surgical treatment of wounded with gunshot wounds of the upper extremity by determining the factors influencing the outcome of treatment of servicemen in modern conditions of specialized and highly specialized medical care.

Materials and Methods. Surgical treatment of 123 patients with gunshot wounds of the upper extremity who were treated at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” and the National Military Medical Clinical Center “Main Military Clinical Hospital” of the Ministry of Defense of Ukraine was analyzed. The mean age of patients was (35.3±8.7). At the level III of medical care, the largest share was occupied by wound closure (28.0%) and surgeries on the skeletal system (6.7%). At the level IV of medical care, the largest share was occupied by surgical procedures for closing unhealed wounds – 28%, due to the consequences of gunshot nerve injuries – 11.5%, fractures – 10.7%, and restorative interventions on muscles – 5.5%.

Results. By calculating the odds ratio (Odds Ratio, OR), it was found that the presence of compartment syndrome reduces the probability of obtaining a positive result by 11 times (OR=11.3), and late treatment at the level IV of care reduces the effectiveness of treatment by 9 times (OR=9.1). In the group of patients with peripheral nerve damage, satisfactory results were 6.9 times less than in the group without such damage (OR=6.9); the presence of a tissue defect worsened the prognosis of treatment by almost 5 times (OR=4.7). The average time to start surgical treatment after a gunshot wound was 2.8±5.0 days at the level III and 47.2±70.4 days at the level IV. It was found that for patients admitted to the level IV facilities for up to 30 days, the percentage increase in upper extremity function was 42.6±11.8 after treatment and 28.5±10.0 at a later start of treatment.

Conclusions. The results of the study of the factors influencing the outcome of treatment prove the need for early (up to 3 weeks) admission of wounded with gunshot wounds to the level IV of medical care.

https://doi.org/10.37647/0132-2486-2021-109-2-10-17
ARTICLE PDF (Українська)

References

Кочин ИВ. Особенности медико-санитарных потерь и организации экстренной медицинской помощи населению и военнослужащим в зоне проведения антитеррористической операции. Журнал «Медицина неотложных состояний». 2015;69(6):44-51.

Kochin IV. Features of medical and sanitary losses and the organization of emergency medical care for the population and military personnel in the area of the anti-terrorist operation. Zhurnal “Meditsina neotlozhnykh sostoyaniy”. 2015;69(6):44-51. [in Russian].

Борзих ОВ, Лакша АМ, Шипунов ВГ, Борзих НО, Савка ІС, Цівина СА. Лікування поранених з дефектами тканин кінцівок. Проблеми травматології та остеосинтезу. 2015;1(1):10-13.

Borzykh OV, Laksha AM, Shypunov VH, Borzykh NO, Savka IS, Tsivyna SA. Treatment of wounded limb tissue defects. Problemy travmatolohii ta osteosyntezu. 2015;1(1):10-13. [in Ukrainian].

Гуманенко ЕК, Самохвалов ИМ, редакторы. Военно-полевая хирургия локальных войн и вооруженных конфликтов: руководство для врачей. Москва: ГЭОТАР-Медиа, 2011. 672 с.

Gumanenko YeK, Samokhvalov IM, redaktory. Field Surgery of Local Wars and Armed Conflicts: A Guide for Physicians. Moskva: GEOTAR-Media, 2011. 672 s. [in Russian].

Заруцький ЯЛ, Запорожан ВМ, Білий ВЯ, Денисенко ВМ, Асланян СА. Воєнно-польова хірургія: пiдруч. для студ. лікарів-інтернів і лікарів - слухачів закл. (ф-тів) післядиплом. освіти. Одеса: Укр. військ.-мед. акад., ОНМедУ; 2016. 415 с.

Zarutskyi YaL, Zaporozhan VM, Bilyi VIa, Denysenko VM, Aslanian SA. Military field surgery: textbook. for students. interns and doctors - students of the class. (faculties) postgraduate. education. Odesa: Ukr. viisk.-med. akad., ONMedU; 2016. 415 s. [in Ukrainian].

Engelmann EWM, Roche S, Maqungo S, Naude DP, Held M. Treating fractures in upper limb gunshot injuries: The Cape Town experience. Orthopaedics & Traumatology: Surgery & Research. 2019;105(3):517-22. Doi: 10.1016/j.otsr.2018.11.002.

Бур’янов ОА, Ярмолюк ЮО, Лось ДВ, Вакулич МВ. Сучасні хірургічні методи лікування постраждалих з вогнепальними пораненнями кінцівок. Травма. 2017;18(2):30-5. Doi: 10.22141/1608-1706.2.18.2017.102555. Burianov OA, Yarmoliuk YuO, Los DV, Vakulych MV. Modern surgical methods of treatment of victims with gunshot wounds of the extremities. Travma. 2017;18(2):30-5. Doi: 10.22141/1608-1706.2.18.2017.102555. [in Ukrainian].

Sari A, Ozcelik IB, Bayirli D, Ayiket O, Mert M, Ercin BS, et al. Management of upper extremity war injuries in the subacute period: A review of 62 cases. Injury. 2020;51(11):2601-11. Doi: 10.1016/j.injury.2020.08.028.

Anantavorasakul1 N, Westenberg RF, Serebrakian AT, Zamri M, Chen NC, Eberlin KR. Gunshot Injuries of the Hand: Incidence, Treatment Characteristics, and Factors Associated With Healthcare Utilization. Hand (N Y) [serial online]. 2021 Apr 22/ Doi: 10.1177/1558944721998016.

Бур’янов ОА, Страфун СС, Шлапак ІП, Лакша АМ, Галушко ОА, Ярмолюк ЮО, та ін. Вогнепальні поранення кінцівок: методичні рекомендації. Київ, 2015. 46 с.

Burianov OA, Strafun SS, Shlapak IP, Laksha AM, Halushko OA, Yarmoliuk YuO, ta in. Gunshot wounds of the extremities: guidelines. Kyiv, 2015. 46 s. [in Ukrainian].

Omid R, Stone MA, Zalavras CG. Marecek, G. Gunshot Wounds to the Upper Extremity. JAAOS. 2019;27(7):e301-e310. Doi: 10.5435/JAAOS-D-17-00676.

Nikica D, Marijan C, Denis G, Zeljko R, Anela D, Egol K. Shotgun Injury to the Arm: A Staged Protocol for Upper Limb Salvage. Military Medicine. 2010;175(3):206-11. Doi:10.7205/MILMED-D-09-00064.

Panattoni JB, Ahmed MM, Busel GA. An ABC Technical Algorithm to Treat the Mangled Upper Extremity: Systematic Surgical Approach. J. Hand. Surg. Am. 2017;42(11):934.e1-934.e10. Doi: 10.1016/j.jhsa.2017.08.017.

Bumbasirevic M, Stevanovic M, Lesic A, Atkinson HDE. Current management of the mangled upper extremity. International Orthopaedics. 2012;36(11):2189-95. Doi: 10.1007/s00264-012-1638-y.

Prasarn ML, Helfet DL, Kloen P. Management of the mangled extremity. Strat Traum Limb Recon. 2012;7:57-66.

Кундієв ЮІ, Палагін ОВ, Лурін ІА, та ін. Система надання медичної допомоги при веденні бойових дій з урахуванням моніторингу життєдіяльності військовослужбовців. Kharkiv Surgical School. 2015;1(70):111-4.

Kundiiev YuI, Palahin OV, Lurin IA, ta in. The system of medical care in combat operations, taking into account the monitoring of the lives of servicemen. Kharkiv Surgical School. 2015;1(70):111-4. [in Ukrainian].

Хоменко ІП, Король СО, Шаповалов ВЮ. Організація надання хірургічної допомоги пораненим на рівнях медичного забезпечення при проведенні антитерористичної операції (операції об’єднаних сил). Військова Медицина України. 2019;19:5-15.

Khomenko IP, Korol SO, Shapovalov VIu. Organization of surgical care for the wounded at the level of medical support during the anti-terrorist operation (joint force operation). Viiskova Medytsyna Ukrainy. 2019;19:5-15. [in Ukrainian].

Цимбалюк ВІ, редактор. Вогнепальні поранення м’яких тканин (досвід антитерорестичної операції/операції об’єднаних сил). Харків: [б.в.]; 2020. 399 с.

Tsymbaliuk VI, redaktor. Soft tissue gunshot wounds (experience of anti-terrorist operation / joint force operation). Kharkiv: [b.v.]; 2020. 399 s. [in Ukrainian].

Цимбалюк ВІ, редактор. Лікування поранених з бойовими травмами кінцівок (за досвідом АТО/ООС). Київ: [б. в.]; 2020. 194 с.

Tsymbaliuk VI, redaktor. Treatment of wounded limbs with combat injuries (according to the experience of anti-terrorist operation / environmental protection). Kyiv: [b. v.]; 2020. 194 s. [in Ukrainian].

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