Случай огнестрельного ранения нижней трети левого предплечья у ребенка 9 лет из охотничьего ружья. Ампутация или реконструкция?

Abstract

The article presents and describes a clinical case of a gunshot wound of the left forearm of a 9-year-old child — a rare case in the practice of traumatologists and pediatric surgeons in peacetime, which occurred during hunting. The child had an open multi-splintered fracture of the lower third of both bones of the left forearm with damage and defect of the radial and ulnar artery, radial, ulnar and median nerves, damage and defect of over 15 cm of the extensor tendons of the left hand and fingers, soft tissue defect and the presence of foreign objects. There was no blood supply, movement and sensitivity on the left hand. Radiographs of the left forearm and hand in front and lateral projections revealed multi-splintered fractures of the lower third of both bones of the left forearm with the presence of foreign objects (pellet). There was a question of reconstruction or amputation of the forearm. Collectively, at a consultation of doctors consisting of: an orthopedic traumatologist, an angiosurgeon, a neurosurgeon, a pediatric surgeon and a pediatric anesthesiologist-resuscitator, it was decided to reconstruct the forearm. Primary surgical treatment of a gunshot wound, restoration of the radial and ulnar arteries, radial median and ulnar nerves were performed; extra-focal osteosynthesis of the left forearm was performed according to G.A. Ilizarov technique. One month after cleansing the wound and the formation of granulations, free autodermoplasty with a full-layer skin flap was performed. An objective examination 4 months after the dismantling of the Ilizarov apparatus revealed that the limb was warm, moderate swelling of the hand remained, and tactile and motor sensitivity were registered. With extensive defects of the soft tissues, vessels and nerves of the limb with gunshot wounds, it is necessary to involve an orthopedic traumatologist, an angiosurgeon, a neurosurgeon, a combustiologist, an anesthesiologist, a plastic surgeon and a medical psychologist.