The effectiveness of intraoperative ultrasound control in removing foreign bodies of soft tissues in military personnel with fragmentation wounds at the stage of specialized surgical care

Abstract

BACKGROUND: The involvement of civilian medical institutions in medical care in military conflicts and counter-terrorism operations has become an important area of the medical support system. Modern methods of surgical navigation make possible minimal invasive, effective and safe removing foreign bodies from soft tissues. Clear understanding of injuries’ character allows better planning of procedures. AIM: Improving the results of treatment of military personnel with fragment wounds by taking into account the character of injury and the use of ultrasound control during removing soft tissue foreign bodies at the stage of specialized surgical care. MATERIAL AND METHODS: Data from 253 case histories who were treated at the State Budgetary Institution RO “Central City Hospital named Semashko”. Indications for the removal of fragments included the size of the fragment over 7 mm, localization near to large vessels and nerve trunks, and an acute purulent process. The patients were been randomized to two groups. Group I (control) included 118 patients in whom surgery was been performed in the traditional way. Group II (main) included 135 patients in whom procedures were performed with ultrasound navigation. The research methods are ultrasound, X-ray, clinical, and statistical. RESULTS: In 164 patients (64.8%), the wounds were of an isolated nature, where fragments were localized in various anatomical areas. 89 patients (35.2%) had combined shrapnel wounds. Of the 118 patients in group I, in whom surgery was performed in the traditional way, 65 patients (55.1%) underwent surgery under local anesthesia, 53 (44.9%) — under general anesthesia (anesthesia is always general). In 135 patients of group II, operations were performed by only one surgeon under local anesthesia. The duration of surgery, surgery invasion and wound infections rate were significantly lower in group II. CONCLUSION: The part of isolated fragment wounds is 64.8%, combined — 35.2%. The use of ultrasound navigation during surgery can significantly improve the effectiveness of surgical treatment of patients with fragmentation wounds: reduce the invasiveness and duration of surgery, blood loss, and the rate of wound infectious complications.