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DOI: 10.1055/s-0042-1750971
Surgical Treatment of Gunshot Multiple Shrapnel Wound of Brachiocephalic Vessels, Trachea, Lung, Stomach
Introduction: In the structure of medical losses during the hostilities in modern conditions, the share of the injuries of the extremities is more than 70% of all injuries. During Russian attack on Ukraine in 2022 we have increase different cases of gunshot wounds of the main vessels of the lower and upper extremities, combined injuries.
Aim: The aim of this study is to analyze the results of treatment and clinical outcomes in patients with Fire blind migrating shrapnel wound of the right shoulder with damage to the subclavian vein, subclavian artery; trachea, right lung, diaphragm, small curvature of the stomach during Russian attack on Ukraine.
Methods: The patient was admitted into our vascular surgery department with Fire blind migrating shrapnel wound of the right shoulder with damage to the subclavian vein, subclavian artery; trachea, right lung, diaphragm, small curvature of the stomach. (picture1).On MSCT angiography the area of lesion of the main vessels of the brachiocephalic area and a fragment of the small curvature of the stomach were visualized (picture 2,3). On the 1st stage of the operation: wide access in the projection of the wound canal and hematoma with the transition to the source of bleeding in the projection of the brachiocephalic trunk, cross-section of the clavicle, cessation of bleeding. (picture 4,5). During the surgery the subclavian vein defect was visualized and sutured (picture 6,7). On the 2nd stage of the operation were performed suturing of the trachea; thoracoscopy - chest organs revision, Bülau drain On the 3rd stage of the operation we performed laparoscopy - removal of the fragment, suturing of the defect. (picture 8). On the 4th stage of the operation: restoration of the integrity of the clavicle with the external fixation device.
Results: In the conditions of providing angiosurgical care in Ukraine, tactics of damage control are started at the institutions of the second level - mobile hospitals and district hospitals
Conclusion: 1 The first and decisive role in the successful arterial reconstruction in difficult cases with arterial damage belongs to the rapid evacuation of the wounded to the specialized level of care. 2. Despite the importance of specialized care, the prehospital phase often decides the fate of the wounded, because the reliability and adequacy of temporary cessation of bleeding from injury to delivery of the wounded to the operating room depends on the success of vascular surgery and saving lives. 3.The treatment of gunshot wounds of the main arteries is a complex multi-level process, which can be done only in the case of close cooperation of related surgical specialties. First of all they are traumatology, reconstructive and plastic surgery, anesthesiology and intensive care.
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
10 June 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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