Multiple Wounds Research Articles

Treatment of Multiple Soft Tissue Maxillofacial Wounds: A Case Report

Introduction: Trauma to the maxillofacial area is a frequent problem in medical emergencies, including injuries caused by external forces such as traffic accidents. These injuries can result in damage to the soft tissues, especially the face, which plays an important role in a person's expression, appearance, aesthetics, and identity. Prompt and appropriate treatment is essential to prevent serious complications, including infection and long-term damage. Case Report: A 21-year-old male patient suffered facial bleeding due to a traffic accident. This incident caused lacerations to the frontal region dextra, palpebra dextra, zygoma dextra, and mental, as well as multiple abrasions to the face. Radiographic examination showed no bone fracture, but the wounds required debridement and suturing of the lacerated soft tissues. Management: The patient was diagnosed with multiple lacerations to the maxillofacial area. Initial measures included Tetagam as anti-tetanus protection, followed by Ceftriaxone as prophylactic antibiotics, Omeprazole to reduce gastric irritation, and Ketorolac for analgesic and anti- inflammatory effects. Wound cleansing and debridement were performed to reduce the risk of infection and preserve healthy tissue. The wound was then sutured with the transpositional flap technique, which allows a change in wound direction to reduce the risk of infection and ensure aesthetic and functional wound closure. Conclusion: Multiple soft tissue wounds of the maxillofacial area due to physical trauma require prompt and appropriate management to prevent serious complications. Debridement, wound cleansing, and the use of transpositional flap technique in the treatment of laceration wounds in this case showed optimal wound healing results without complications. Keywords: Transpositional Flap, Maxillofacial, Soft tissue trauma, soft tissue wound, debridement

Pseudoaneurysm of the Lingual Artery in a Patient With Facial Trauma From Gunshot Wounds

A pseudoaneurysm is an abnormal dilatation within the wall of a blood vessel due to the formation of a hematoma in the vessel wall after vessel injury. Because of the protective nature of the facial skeleton and the deep location of the lingual artery, the lingual artery pseudoaneurysm is rare. The authors report a case of a 20-year-old male who suffered multiple gunshot wounds, including to the mouth, presenting with immediate life-threatening injuries. On hospital day 1, otolaryngology performed debridement of the mandible, retrieval and removal of bullet fragments, intermaxillary fixation, external fixation of the mandible, intra-oral laceration repair, repair of tongue laceration, and tracheotomy revision. On postoperative day 15, the otolaryngology service was called for the abrupt onset of major oral cavity bleeding. computed tomography-angiogram detected a pseudoaneurysm of the lingual artery and was successfully treated with endovascular coil embolization.

Оказание хирургической помощи пострадавшим от применения огнестрельного оружия ограниченного поражения в Арктической зоне Архангельской области

Summary. The aim of the study was to estimate the surgical care provided to the victims of traumatic weapons in the Arctic zone of the Arkhangelsk region. Materials and methods of research. We conducted a document-based statistical study using the records from 248 case histories (statistical form # 003/u) filled in for the victims of traumatic weapons, who received medical care in medical facilities of Arkhangelsk and Severodvinsk cities, located the Arctic Zone of Russia in 2005-2022. The research methods are analytical and mathematical-statistical. Categorical variables presented as percentages and frequencies were used for the analysis. The values of all relative quantities were calculated using the WinPepi program. The severity of the injuries was assessed using the VPKh-P(OR) scale, developed under the supervision of Major General of the Medical Service, Professor E.K.Gumanenko (1990) at the S.M.Kirov Military Medical Academy. The results of the study and their analysis. Every third victim of limited-damage firearms in the Arctic zone of the Arkhangelsk region required inpatient surgical care with the involvement of surgeons of various specialties. In case of multiple and combined wounds, it was necessary to involve two or more surgeons of various profiles. In case of minor wounds from limited-damage firearms during primary surgical treatment, the severity of the wound is underestimated by surgeons and, as a result, the bullet is not initially detected and remains in the wound, which, in turn, complicates the condition of the victim and requires repeated surgical intervention. In 39% of cases of wounds from limited-damage firearms to the head, every fifth case (21.9%) of wounds to the chest, every tenth case of wounds to the abdomen – specialized surgical care is required, the availability of which in the Arctic zone can be very problematic.

Special-form radial collateral artery perforator flaps for the reconstruction of complex hand defects

BackgroundThe reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications.MethodsFrom June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases.ResultsAltogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps.ConclusionsThe free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.

Double-network polyphenol chitosan hydrogels with instant aldehyde-β-cyclodextrin-based structure as potential for treating bacterially infected wounds

Treatment of multiple bacterial infected wounds by eliminating bacteria and promoting tissue regeneration remains a clinical challenge. Herein, dual-network hydrogels (CS-GA/A-β-CD) with snap-structure were designed to achieve curcumin immobilization, using gallic acid-grafted chitosan (CS-GA) and aldehyde-β-cyclodextrin (A-β-CD) crosslinked. A-β-CD were able to achieve rapid dissolution (≥222.35 mg/mL H2O), and helped CS-GA/A-β-CD achieve rapid gelation (≤66.23 s). By adjusting the ratio of aldehyde groups of A-β-CD, mechanical properties and drug release can be controlled. CS-GA/A-β-CD/Cur exhibited excellent antimicrobial properties against S. aureus, E. coli, and P. aeruginosa. In vivo experiments demonstrated that CS-GA/A-β-CD/Cur achieved acute bacterial infection wound healing after 20th days, proving its great potential for wound dressing.

FORENSIC EVALUATION OF SELF-INFLICTED SUICIDES WITH MULTIPLE GUNSHOT WOUNDS

Suicide is a common cause of premature death and a serious social problem. The use of firearms for suicide is quite common. The infliction of multiple self-inflicted wounds, including a fatal one, is rare among suicides, but it is possible and requires careful investigation. Aim To provide a forensic assessment of the possibility of suicide by multiple gunshot wounds. Methods. Archival material from the Kyiv City Clinical Bureau of Forensic Medicine and the Zhytomyr Regional Bureau of Forensic Medicine (2 "medical examination reports") was used. The objects of the study were: gunshot wounds on the head (wounds, wound channels), elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov", shot products, pistol "Makarov-MP 79" converted to shoot elastic bullets. Their characteristics were examined visually and under the stereo microscope. The detection of shot soot layers on skin flaps and gunsmith's grease was carried out in infrared and ultraviolet rays. The study of the elemental composition of shot products in objects of biological and non-biological origin was carried out using the X-ray fluorescence spectrometer "M4 TORNADO". Standard methods of variational statistics were used in the study. Results. The forensic examination of the entry and exit wounds and wounds on the head of the corpses of persons who died as a result of self-inflicted gunshot wounds, as well as of the bullets and weapons that caused bodily injuries, confirmed the possibility of committing suicide by firing double shots from pistols to shoot bullets of the so-called "non-lethal type": elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov". It was established that in case No 1 the first injury was non-fatal and the second was fatal, accompanied by damage to the skull and brain. In case No. 2, the first wound was fatal and the second was non-fatal, as it damaged only the soft tissues of the head without damaging the bones of the skull and brain. The wounds were caused by automatic shots due to the poor technical condition of the weapon, i.e. partial damage and wear of the trigger mechanism and the pistol sear. This was facilitated by a one-time partial self-destruction of the weapon, followed by the wedging of the next cartridge with an elastic bullet in the lower part of the barrel. Conclusion. Thus, the cases of double head injuries caused by shots from firearms (pistols) for shooting bullets of the so-called "non-lethal type" (elastic bullets up to 9 mm cartridges and 9 mm bullets for pistol "Makarov") serve as evidence of suicide. In case No. 1, one of the wounds was not fatal, as the wound channel began with an entrance hole in the lower half of the right temporal region, continued on the right through the right mastoid process and the soft tissues of the neck, and ended in the middle with an exit wound in the back of the neck. This wound was the first inflicted. The second wound was final and fatal, as there was damage to the skull and brain, as evidenced by the wound channel which passed through the right temporal cyst, the brain and its membranes, the left occipital bone, and ended with the exit wound in the left occipital region. It was the second in order of entry. In case 2, the first wound was fatal, resulting in damage to the bones of the skull and brain and the presence of an elastic ball in the substance of the brain. The second wound was non-fatal and tangential, injuring only the soft tissues of the head without damaging the bones of the skull and brain. It occurred as a result of automatic (independent) shots due to the poor technical condition of the weapon, namely partial damage and wear of the trigger mechanism and the pistol sear. This was facilitated by a one-time partial self-destruction of the weapon, followed by the wedging of the next cartridge with an elastic bullet in the lower part of the barrel.

Case Report: Multidisciplinary management of severe blast-related craniofacial and ocular injuries at artisanal gold mining sites in Niger: An unusual case report and comprehensive literature review

Blast-related craniofacial and ocular injuries have traditionally been associated with battlefields. In civilian populations, these injuries were infrequent, primarily arising from accidental explosions or terrorism incidents. Explosions can inflict severe damage to the neurological, ocular, and auditory systems through blast waves, high-velocity foreign bodies, and thermal radiation. The pathophysiology of blast-related craniofacial injuries is specific and complex, with severe cases often involving both penetrating and blunt trauma, leading to high mortality and morbidity rates. These injuries necessitate multidisciplinary management and can be defined as intracranial polytrauma. Recently, Niger has seen a surge in blast injuries, predominantly due to the increase in clandestine artisanal gold mining. Managing these injuries in resource-limited settings poses significant challenge. Comprehensive national data on these injuries are sparse due to high pre-hospital mortality rates and their infrequent occurrence, resulting in limited experience among our local physicians in their management. We present a rare case involving an artisanal gold miner with a history of smoking and previous concussions from explosion exposures. The patient was transferred to our hospital following severe craniofacial and ocular injuries caused by an accidental dynamite explosion at a mining site. On admission, the patient presented altered consciousness, agitation, unstable vital signs, multiple craniofacial wounds, including a large frontal wound with brain substance extrusion, diffuse facial burns, left globe rupture, and rhinorrhagia. After resuscitation and stabilization, brain imaging revealed multiple complex craniofacial fractures with foreign bodies. The patient underwent multidisciplinary surgical management. However, the postoperative course was complicated by post-concussive syndrome, and infection of the surgical wounds, necessitating surgical revision. Following the second surgery, the postoperative course was uneventful, although the patient experienced reduced visual acuity. This case highlights the management challenges in Niger and underscores the urgent need for clinical studies and training for gold miners to enhance safety practices in their activities.

Enhancing trauma evaluation: Comparative analysis of post-mortem computed tomography and autopsy findings in abdominal stab wounds.

In cases of traumatic deaths, accurate assessment of injuries is essential for both legal and medical purposes. This case report compares the findings of post-mortem computed tomography with conventional autopsy methods in assessing abdominal stab wounds. A 34-year-old woman with multiple stab wounds in the abdomen underwent post-mortem examination, including computed tomography imaging. Computed tomography revealed specific breaches in the skin's continuity and internal injuries, including perforation of the stomach. A conventional autopsy confirmed the presence of multiple stab wounds and associated injuries to internal structures. However, additional injuries to major blood vessels, such as the abdominal aorta and inferior vena cava, were only detected during manual exploration of the peritoneal cavity. This case highlights the complementary roles of post-mortem computed tomography and conventional autopsy in evaluating traumatic injuries. While computed tomography imaging offers non-invasive visualisation of injuries, manual examination remains essential for identifying certain injuries, particularly those affecting major blood vessels. The integration of computed tomography imaging with traditional autopsy methods enhances the accuracy and reliability of forensic assessments in cases of traumatic deaths, particularly in complex cases involving multiple injuries. Understanding the strengths and limitations of these techniques is crucial for improving forensic investigations and ultimately enhancing medico-legal outcomes.

Wartime penetrating skull base trauma with unpredictable internal fragment ricochet and migration: illustrative case.

Transnasal transsphenoidal penetrating craniocerebral injury is very rare even in wartime. Cases with good outcomes are even less common. A 20-year-old male sustained multiple fragment wounds to his head and face from a landmine explosion. One metal fragment entered his right nostril, traversed the nasal septum and anterior sphenoid sinus, and ricocheted superiorly off the clivus. The fragment then traveled almost to the surface of the left parietal lobe. Subsequently, under its own weight, it migrated back down its original track. The patient suffered cerebrospinal fluid rhinorrhea, pneumocephalus, and right-sided hemiparesis. Digital subtraction angiography was followed by microscopic transnasal skull base reconstruction supplemented by external lumbar drainage. Follow-up brain computed tomogrpahy showed further metallic fragment migration through the ventricular system. The fragment was removed through a transcortical approach. The patient's neurological examination and brain magnetic resonance imaging results demonstrated good recovery. The absence of external signs of deep injuries does not exclude the presence of a penetrating craniocerebral injury. Metal fragments may undergo ricochet and internal migration in both the brain parenchyma and the ventricular system. Timely diagnosis including three-dimensional reconstruction of a projectile's trajectory may facilitate appropriate surgical planning in complex cases. Intraventricular fragment migration may necessitate microsurgical removal. https://thejns.org/doi/10.3171/CASE24128.

Non-lactational mastitis with multiple sinus wounds treated by integrated traditional Chinese and Western medicine

Non-lactational mastitis with multiple sinus wounds treated by integrated traditional Chinese and Western medicine

Pulmonary Embolism of the Small Branches of the Pulmonary Artery as a Result of Combat Trauma: Review of the Literature and Analysis of a Clinical Case

Pulmonary embolism (PE) is recognized by WHO as one of the most common cardiovascular diseases. Even in peacetime, PE is the third leading cause of sudden death after coronary heart disease and stroke. Today, as a result of the war, there have been significant corrections in the understanding of etiology, pathogenesis, features of the clinical course and treatment of internal pathology in the wounded persons. It was established that an important feature of modern combat activity is a constant increase in the frequency of multiple and combined wounds, while combat injuries of the chest make up to 15% of the structure of sanitary losses, and closed chest injuries under combat conditions can make up to 5%. Diseases of the cardiovascular and respiratory system are observed both early and late after closed chest trauma. The early ones are represented by functional disorders of the blood circulation and breathing system and are the consequences of damage to the chest organs, and the late ones occur in the case of joining a wound infection and are characterized by inflammatory processes in the lungs, pleura, heart and blood vessels, include pneumonia, pleurisy, acute purulent-destructive diseases lungs, thromboembolic complications. The article analyzes the course and possibilities of diagnosis and treatment of PE using the example of a wounded military man. A clinical case is presented which describes the successful diagnosis and treatment of a wounded person with PE of small branches of the pulmonary artery with the development of infarct-pneumonia S8, S9 of the right lung, nosocomial pneumonia in the right lung, which was complicated by the destruction of lung tissue, with the formation of an abscess-hematoma, acute interstitial nephritis, complicated by acute kidney damage of the III degree. This therapeutic pathology arose after a gunshot shrapnel penetrating wound of the chest on the right side with damage to the right subclavian vein, migration and embolization by a metal fragment of the right pulmonary artery, a gunshot shrapnel blind wound of the upper third of the right forearm with a gunshot fracture of the ulna and the presence of a foreign body (debris) in the muscle what tissues of the forearm. During the operation a complication arose in the form of migration of a foreign body from the branches of the right pulmonary artery to the branches of the left pulmonary artery. The result of the patient’s treatment was positive dynamics of the pathological process. The serviceman was discharged from the hospital in satisfactory condition and returned to the Armed Forces of Ukraine after a medical treatment. PE of small branches of the pulmonary artery is a severe complication after gunshot shrapnel injury to the chest organs, which can occur without concomitant deep vein thrombosis of the lower extremities, most likely as a result of the development of shock and the migration of fragments along the branches of the pulmonary artery. Complex treatment with the use of surgical methods and adequate antibacterial therapy is the main method of treatment of chronic destruction of lung tissue with abscessation. Each patient needs a complex of imaging methods for dynamic examination and monitoring of the state of other organs and systems, in particular, kidney function.

Hyperacute Radiation Pneumonitis after Severe irAE.

A 54-year-old woman presented to an outpatient clinic with a recurrence of triple-negative breast cancer and multiple bone metastases. The patient had a large mass lesion of 10 cm on the sternum. She received the immune checkpoint inhibitors pembrolizumab and taxane. Initially, the patient responded excellently to treatment, but stopped pembrolizumab for grade IV skin toxicity with multiple ulcerative wounds over the bilateral leg and trunk. The lesions abated following administration of antibiotics and oral prednisolone for two months. After that, she was referred to the radiation oncology department for further treatment. She received radiotherapy for the sternum mass but stopped radiation at 42Gy/21 fractions for severe dyspnea and fever. Blood sampling found leukocytosis with neutrophil predominance. Chest radiography showed bilateral lung infiltration. Pulmonary CT scan yielded bilateral lung patchy consolidation compatible with radiation isodose-line. Bronchial lavage showed positive Pneumocystis jiroveci PCR. Dyspnea improved after titrating methylprednisolone within two days. The patient recovered well with TMP-SMX and glucocorticoids after the initiation of therapy.

Intelligent In situ Printing of Multimaterial Bioinks for First‐Aid Wound Care Guided by Eye‐In‐Hand Robot Technology

AbstractINSIGHT (INtelligent in situ printing Guided by Eye‐in‐Hand robot Technology), an innovative computer vision‐enabled system that combines a depth camera with a 6‐degree of freedom robot arm, empowering it to identify arbitrary areas at various angles through real time adjustments and to enable volumetric printing performed by dynamic image recognition based on color and contour differences is presented. Continuous targeting of multiple wounds at different locations is achieved. The optimized pneumatic valve synchronized with the INSIGHT can print multiple inks with diverse rheological properties to fabricate scaffolds and bandages with the capacity to treat various types of wounds. The design of dual printed modes, such as extrusion and spray, can significantly decrease printing time for large‐scale wounds on an ex vivo porcine model. INSIGHT demonstrates its ability to treat diabetic wounds, using a microgel‐based ink possessing an inherent porous microstructure to facilitate cell infiltration. In vivo verification highlights its adaptability to enable customized care for rapid emergency treatment of trauma patients.

A Swine Burn Model for Investigating the Healing Process in Multiple Depth Burn Wounds.

Burn wound healing is a complex and long process. Despite extensive experience, plastic surgeons and specialized teams in burn centers still face significant challenges. Among these challenges, the extent of the burned soft tissue can evolve in the early phase, creating a delicate balance between conservative treatments and necrosing tissue removal. Thermal burns are the most common type, and burn depth varies depending on multiple parameters, such as temperature and exposure time. Burn depth also varies in time, and the secondary aggravation of the "shadow zone" remains a poorly understood phenomenon. In response to these challenges, several innovative treatments have been studied, and more are in the early development phase. Nanoparticles in modern wound dressings and artificial skin are examples of these modern therapies still under evaluation. Taken together, both burn diagnosis and burn treatments need substantial advancements, and research teams need a reliable and relevant model to test new tools and therapies. Among animal models, swine are the most relevant because of their strong similarities in skin structure with humans. More specifically, Yucatan minipigs show interesting features such as melanin pigmentation and slow growth, allowing for studying high phototypes and long-term healing. This article aims to describe a reliable and reproducible protocol to study multi-depth burn wounds in Yucatan minipigs, enabling long-term follow-up and providing a relevant model for diagnosis and therapeutic studies.

Multiple suicidal gunshot wounds. Case reports and mini-review of literature.

To determine the manner of death (MOD) and, there-fore, to classify the event as natural, suicidal, homicidal, or accidental is an essential and routine task in forensic medicine. The evaluation of MOD presents numerous difficulties due to unusual anamnestic and circumstantial data, in addition to autopsy findings and postmortem findings. A mini review of the literature on the topic was performed. Here we report two cases of uncommon self-inflicted multiple GWs (SMGWs) to the head and thorax, suspected of killing. The presence of more than one gunshot wound is suggestive of homi-cide, especially when they involve the head. A review of the literature on the topic was performed on PubMed's database, showing, although considered infrequent, cases documenting SMGWs are not rare. In the cases reported, the initial suspicion of involvement of third persons was excluded through the examination of the death scene, post-mortem (CT and autopsy) findings and clinical-circumstantial data. The analysis derived from the review of the related literature allowed us to highlight the presence of common findings which should be considered in the evaluation of such cases.

Achilles Tendon Rupture Treated with Flexor Digitorum Lateralis Tendon Transposition and Transarticular External Skeletal Fixator in Ouessant Sheep

Abstract Objective To describe the appositional augmentation of a complete Achilles tendon rupture in Ouessant sheep, using the intact flexor digitorum lateralis tendon, and immobilization with a type II transarticular external skeletal fixator. Clinical Report A 1-year-old neutered male Ouessant sheep was presented for Achilles tendon rupture and multiple bite wounds, secondary to a dog attack. The Achilles tendon was torn entirely, and a significant 3-cm gaping defect was present. The remnants of the Achilles tendon were debrided and attached using locking-loop and epitendinous sutures. The intact flexor digitorum lateralis tendon was then transposed and secured over the tendinous repair to increase the tendon strength. The bite wounds were closed with a primary repair. Finally, a type II transarticular external skeletal fixator was used to immobilize the tarsocrural joint for 6 weeks. Results A mild lameness, associated with a decreased range of motion of the tarsocrural joint, was present at the time of external skeletal fixator removal. Four months postoperatively, the lameness had completely resolved. A slight decrease in the range of motion of the tarsocrural joint was conserved. Clinical Significance In a small ruminant, transposition of the flexor digitorum lateralis was successful for the repair of an Achilles tendon rupture with a large musculotendinous gap and infected open wounds. To the authors' knowledge, this is the first such case described in sheep.

Versatility in the Use of Cadaveric Skin Grafts for Wound Management

Background. Cadaveric skin grafts were initially used for the management of acute burn wounds. The biological coverage of the wound improves the quality of the wound bed, which prepares it to receive an autologous skin graft. The benefits of cadaveric skin graft in burn wounds have led to its use in the management of acute and chronic wounds of diverse etiologies. Objective. To evaluate the use of cadaveric skin graft and subsequent autologous split-thickness skin graft (STSG) in the management of wounds of diverse etiologies at a single institution. Materials and Methods. A retrospective analysis was performed of patients with wounds of different etiologies managed with cadaveric skin grafts followed by a second procedure in which autologous STSG was performed from May 2017 through May 2022 in the Plastic and Reconstructive Surgery Department of German Hospital, Buenos Aires, Argentina. Results. A total of 25 patients with wounds of different etiologies were included. The mean affected body surface area (BSA) was 1.87%. The mean engraftment percentage of the cadaveric skin graft was 96.6%. The mean engraftment percentage of the STSG was 90.6%. All patients demonstrated improvement in local edema and inflammation, reduced secretions, and reduced pain after treatment. Two patients (8%) had complications, with 1 case of delayed healing of the donor site and 1 case of hypertrophic scarring. Conclusions. Cadaveric skin graft with subsequent STSG is a simple, safe, and effective alternative for the management of complex wounds of diverse etiologies. This technique is particularly useful in patients with multiple comorbidities who are at risk of recurrence and of developing multiple wounds during their lifetime.

Morphological Features of Wound Canals and Intracranial Pathology in Non-Penetrating Gunshot Craniocerebral Injuries

Background. Non-penetrating craniocerebral trauma in modern warfare, according to our data, accounts for up to a fifth of all gunshot wounds of the skull and brain in armed conflicts at the end of the last century and the beginning of the current century. It is a complex problem of military field surgery, first of all from the point of view of solving an important task of the medical services of the warring parties – restoring the maximum number of wounded. The study of pathomorphological wound channels in various types of gunshot non-penetrating craniocerebral injuries gives opportunities for the development of adequate options for access during surgical treatment. 
 Object: to reveal the morphological features of wound canals and internal cranial injuries in gunshot non-penetrating craniocerebral injuries for optimal planning the primary surgical treatment of the wound.
 Material and Methods. Study and analysis of morphological features of wound canals and intracranial pathology in 155 non-penetrating gunshot craniocerebral injuries of the military who underwent surgical treatment in the 2nd and 3rd level healthcare institutions during the war in 2014-2020. The morphology of wound canals and intracranial injuries were studied based on the laws of wound ballistics, clinical data, and computed tomography data.
 Results. The largest proportion of non-penetrating gunshot wounds is perforated and depressed fractures (39.9%); perforated fractures with penetration of a fragment to the inner plate of the bone account for 20% and incomplete (to the bone) make up 5.8%. Among blind non-penetrating wounds, single ones prevail (65.2%). More often, they have a cylindrical blind canal. Subarachnoid hemorrhage, brain congestion, and very rarely epidural hematoma (one case) are found in almost all perforated bone fractures. A more complex pathomorphological structure is present in multiple non-penetrating gunshot wounds. At the same time, only one fragment causes a depressed skull fracture. Large and small wound canals can be distinguished by width. The latter do not damage the bones and do not require surgical treatment. This type of injury is accompanied by a subarachnoid hemorrhage in 78% of cases and by brain congestion near the fracture in 43% of cases. Tangential injuries occur in 21.9% of injuries; they have a grooved elongated shape. The bottom of these wounds are linear and compressed fractures. Rarely, subdural and intracerebral hematomas are formed in the projection of the fracture. All non-penetrating injuries are accompanied by small brain congestion of the I-II degrees and subarachnoid hemorrhage. Epidural and intracerebral hematomas can rarely occur with blind non-penetrating cranial injuries.
 Conclusions. Non-penetrating multiple fragmental injuries are accompanied by the greatest soft tissue damage. In case of blind wound canals, there are incomplete perforated and perforated-depressed skull fractures; linear and depressed fractures occur in tangential canals. Regardless of the type of wound canals in the brain, there are small congestions (hemorrhages) and subarachnoid hemorrhage. In rare cases, epidural and intracerebral hematomas are formed. Subdural hematomas, sometimes combined with intracerebral hematomas, are found in tangential non-penetrating wounds. Projectiles in tangential wounds do not cause molecular shock and do not lead to secondary necrosis, therefore, it is not necessary to cut the edges of the wound during the primary surgical treatment.

Successful mechanical thrombectomy for terminal ICA bullet embolism: A case report

Bullet embolism after high velocity penetrating trauma is a rare event that can have devastating and wide-ranging effects distant from the original site of injury. A 29-year-old presented with multiple gunshot wounds to the chest, back, abdomen, and lower extremities but no penetrating head injury. After proper resuscitation, the patient was noted to have left-sided hemiparesis and computed tomography angiography of the head showed a bullet fragment that had traveled to the right M1 segment of the middle cerebral artery resulting in occlusion of the vessel. Mechanical thrombectomy was performed in an attempt to remove the bullet fragment but this was unsuccessful as the fragment was firmly lodged in the blood vessel. Aspiration of clot distal to the fragment was then performed in hopes of preventing a large volume ischemic event which was angiographically successful resulting in TICI 2c revascularization. This case demonstrates that thrombectomy can be safely and successfully performed distal to a lodged foreign body.

Predictors of death in seriously injured patients

The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.