Наукові праці. Кафедра хірургії № 4

Permanent URI for this collectionhttps://repo.knmu.edu.ua/handle/123456789/1519

Browse

Now showing 1 - 20 of 64

Changes in the thyroid hormone status of the wounded depending on the volume of wound damage
(2024) Misiura, K.; Lurin, І.; Seliukova, N.; Boiko, M.; Tykha, I.; Nehoduiko, Volodymyr; Kalashnyk, S.
The wound process is considered to be the local and general organism’ responses which are developed to damaged tissues. The number of individuals with combat trauma was extremely increased due to Russia’s armed aggression against Ukraine started in February 2022. The wound healing and the course of wound process depend on large number of factors one of them is thyroid status. The impact of thyroid hormones on the particularities of combat traumas’ healing is the background of this investigation. The purpose of this research was to determine the link between wound sizes and thyroid hormones serum level at different period of the wound process. Material and methods. 30 militaries with wounds of soft tissues of different sizes have taken part in this study. The average age of wounded men was 34.2 ± 4.3. The average body mass was 78 ± 3.5 kg. Free T3 and T4, thyrotropic hormone (TTH) concentrations have been determined. Results. During investigation free T3 concentration was at level 3.4–5.2 pmol/L and hasn’t statistically changed in all the participants comparing to its concentration within 1–3 days. The concentration of free T4 did not differ in militaries with minimal as well as with mild injuries. The levels of free T4 hormones were signifi cantly (р < 0.05) higher in severely wounded men during the entire duration of the investigation. TTH levels considerably (р < 0.05) increased in wounded men with severe and mild wounds in compare with participants with minimal wounds on 1–5 days. However, the concentration of TTH significantly (р < 0.05) declined in the all groups of wounded on 14 day of the investigation. Conclusions. The concentrations of free T4 and thyrotropic hormone significantly increased in wounded men with severe and mild wounds on 1–5 days after wounding. The concentrations of free T3 haven’t considerably changed
Clinical classification of liver cirrhosis - a way to plan individual definitive treatment
(2024-12-01) Petiunin, Oleksii; Shevchenko, Rostislav; Brek, Ostap; Kolomensky, Oleksii
Aim: To develop clinical classification of liver cirrhosis, which can aid individualization and planning definitive treatment for this group of patients. Materials and Methods: Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: “liver”, “cirrhosis” and “classification”; or “liver”, “cirrhosis” and “complications”; or “liver”, “cirrhosis” and “treatment”; or “portal” “, “hypertension” and “complications”. Articles were independently evaluated by each author, the etiological, orphological and current clinical classifications of LC were analyzed, their advantages and disadvantages identified, and after discussion classification of LC was developed by consensus. Conclusions: The developed clinical classification of liver cirrhosis will facilitate the planning of therapeutic tactics for each patient, allow to personalize the treatment of patients with this pathology.
Clinical effects of ligation of left gastric artery and vein, splenic artery in patients with liver cirrhosis and secondary hypersplenism
(2023-09-25) Petiunin, Oleksii; Feskov, Volodymyr; Konoplia, Lina
Computational modeling and analysis of wound formation in gunshot injuries
(2023) Larin, Oleksiy; Tomashevskyi, Roman; Lurin, Igor; Gumeniuk, Kostyantyn; Nehoduiko, Volodymyr
This research aims to investigate the physical processes accompanying high-speed element penetration in gunshot wounds and understand the formation of wound channels, trajectory characteristics of bullets, and damaging effects on surrounding tissues. The study utilizes 3D computer modeling to simulate highspeed element penetration based on the 3D finite element method (FEM). The paper presents a methodology of computer simulation with mathematical basics and algorithmic descriptions. The approach uses direct explicit numerical integration over time for the impact of the metallic bullet into the gelatin block specimen that analyses within the framework of its plasticity considering the nonlinear pressure dependence in a shock wave. The algorithm of simulation incorporates the process of material destruction, where elements that reach critical strain values are removed from the model. The study provides insights into the behavior of different bullet types and their impact on tissue deformation from computational experiments that simulate the penetration into ballistic gelatin of two types of bullets, the 7H6M type, and the V-max type. The simulation results reveal the distribution of equivalent stresses in the wound channel at different moments in time. Additionally, the study analyses the penetration depth and diameter of the damaged material for both bullet types. The developed 3D computer modeling method can serve as a valuable tool for further investigations, facilitating the development of advanced medical treatments.
Features of general surgery teaching to medical students
(ТДМУ, 2016-05) Tsyganenko, Oksana; Shevchenko, Stanislav
The subject «General Surgery» is one of the basic disciplines, laying foundation for study of surgical activity, which is required for every physician-clinician, regardless of his or her further specialization. In modern socioeconomic conditions, only a widely educated physician, who can  exibly rebuild direction and content of his or her activities taking into account changing requirements and the advent of new medical technologies is of the true value to health care service.
Features of the use of ladder myoplasty of a gunshot wound to the laryngopharynx: Case report
(2023-10-01) Lurin, I.; Makarov, Vitaliy; Khoroshun, Eduard; Nehoduiko, Volodymyr; Shypilov, Sergiy; Smolianyk, Kostiantyn
Introduction and importance: The laryngopharynx wound is considered to be one of the most severe wounds of neck both in war and in peace, as it may cause life threatening changes in the whole body (asphyxia, bleeding, shock). Important aspects of surgical treatment are to ensure full breathing, acceptable ways of feeding, and the use of reliable wound closure techniques aimed to prevent digestive tract failure and to maintain the framework and aerostasis of the laryngotracheal region. Case presentation: A case of unilateral multiple wounds of the laryngopharynx was described in the article. The features of diagnostics, surgical treatment and conservative therapy in the postoperative period with this injury were presented. The wounded man was urgently operated. During surgery the pharynx was mobilized. The metal fragment was removed. The wound of the pharynx was sutured with a two-row suture. The next stage of the surgical treatment was myoplasty. In the case of the patient, the purpose of myoplasty was additional sealing of the pharyngeal suture and myoplasty of the thyroid cartilage injury zone for the purpose of aerostasis. Because of the size of the wounds and their anatomical localization, we used the mobilized lower edge of the Musculus sternocleidomastoideus for myoplasty and proposed the method of ladder myoplasty developed by us. Clinical discussion: In myoplasty method the following criteria must be followed: the muscle flap must be of sufficient length and width, so as not to cause excessive tension in the myoplasty area; the flap must be thick enough to avoid necrosis that may cause subsequent infectious complications; when taking the flap, the most sparing operative access should be used to avoid functional and anatomical disorders; the volume of the taken muscle flap must not lead to functional and anatomical disorders. Conclusion: The proposed method of ladder myoplasty using Musculus sternocleidomastoideus is unique, and proves its high efficiency in unilateral multiple laryngopharyngeal injuries, and can be recommended for wide clinical implementation in such clinical situations.
Gunshot shrapnel wound of the thigh with damage to the superficial femoral artery (features of clinical manifestations, development of complications with late medical care and preservation of the limb)
(2023) Lurin, I.; Makarov, Vitaly; Nehoduiko, Volodymyr; Smolianyk, Kostiantyn; Chobey, S.; Ott, O.
The aim:To demonstrate the features of clinical manifestations and complications that occur with delayed medical treatment in cases of gunshot shrapnel through a wound of the thigh with damage to the superficial femoral artery. Materials and methods: The wounded individual, S., was 52 years old and had sustained a gunshot wound through a shrapnel wound of the left thigh with damage to the superficial femoral artery and soft tissue defect. Medical assistance was provided during the stages of medical evacuation. Results: The soldier sustained a gunshot wound through the upper third of the left thigh, resulting in damage to the vascular-nerve bundle and a soft tissue defect. First aid was provided at the scene, and surgical procedures were performed during the stages of medical evacuation, including primary surgical treatment of wounds in the upper third of the left thigh. On the second day following the injury, the wounded man was transferred to the Vinnytsia Military Medical Clinical Center and admitted to the vascular surgery department. After an ultrasound examination and repeated surgical treatment of the wound on the left thigh, damage to the superficial femoral artery was identified. Conclusions: The presence of features of blood circulation in gunshot wounds of the main vessels of the lower limbs can favorably affect the possibility of saving the limb, as evidenced by the case presented.
Mathematical Modelling of the Multifactorial Influence of Striking Fragments on the Dynamics of the Rehabilitation Processes of the Wounded.
(2023) Kolisnyk, Kostiantyn; Sokol, Yevgen; Shchapov, Pavlo; Nehoduiko, Volodymyr
The article analyses the possibility of solving an important scientific and technical problem that is relevant for the security and defence of any country where natural and man-made disasters, military conflicts and other emergencies occur, in which penetrating injuries of people occur. The article reports on the possibility of improving the efficiency of the rehabilitation technology for patients with penetrating gunshot wounds by reducing the rehabilitation period using modern methods of medical diagnostics, mathematical modelling and statistical methods for processing biomedical information. The scientific idea underlying the conducted research is that dynamic changes of a set of biomedical indicators depend not only on the time of their observation, but also on the levels of those physical factors that characterize physical parameters: temperature and dynamics of fragments. As a working hypothesis, in this case, it is possible to consider the inverse task, in which it is possible to solve the problem of assessing the levels of physical factors characterizing fragments using measurements of biomedical indicators during the initial examination of the wounded. In the paper, the authors substantiated the possibility of using primary biomedical measurements to assess the physical characteristics of fragments. This, in turn, makes it possible to take into account the characteristics of the physical impact of fragments on the dynamics of changes over time in biomedical indicators characterizing the treatment, and will lead to a reduction in rehabilitation time
Method for measuring X-ray reflections of microelements of inorganic compounds in soft tissues
(2023-07-25) Mikhailov, I.; Negoduyko, Volodymyr; Mikhaylusov, R.; Mikhailov, A.; Borisova, S.
An alternative method is proposed for measuring X-ray diffraction peaks from micro-impurities of inorganic phases in soft tissues. Unlike traditional XRD, each of the diffraction peaks corresponding to the interplanar spacing di , is measured using radiation with a wavelength of λi →2di . This makes it possible to register diffraction peaks at large θ angles, thereby increasing the angular resolution ∼tanθ. This approach made it possible to increase the beam angular divergence ∆θ from 0.05° (for standard XRD) to 3°, gain ∼(∆θ) 2 in the spectrometer luminosity, and reduce ∼(∆θ) -2 radiation load per unit area of soft tissue. A criterion for choosing the wavelength and beam divergence based on the micro-impurity structure is proposed. The results of measuring the diffraction peaks of micro-impurities of iron oxides in soft tissues damaged by a fragment wound are presented. The excess iron content in damaged tissues was certified by the XRF method with calibration using standard samples and did not exceed 0.4 mass%. Measurements of the main diffraction peaks of iron oxides Fe2 O3 , d=2.69Å, as well as Fe3 O4 , d=1.61Å and FeO(OH), d=1.71Å, were carried out in Cl- Кα ( . λ = 4 728 ) and Sc-Кα ( λ = 3. ) 031 , respectively. We used the scheme of a portable EDXRF spectrometer with a secondary KCl-Sc target and an angular beam divergence of ∆θ≈3°. Without radiation damage to soft tissues, the detection limits were reached: 0.12 mass% for Fe2 O3 , 0.059 mass% for Fe3 O4 and 0.034 mass% for FeO(OH)
Methodology and use of experimental techniques in analyzing wound dynamics of penetrating injuries
(2023) Tomashevskyi, Roman; Larin, Oleksiy; Kolisnyk, Kostyantyn; Zuev, Andrey; Gumeniuk, Kostyantyn; Lurin, Igor; Nehoduiko, Volodymyr
This research paper focuses on the experimental studies of the process of high-speed object penetration into human body simulators and the automated registration of physical phenomena parameters related with this process. It highlights the need for a comprehensive understanding of the physical processes involved and the challenges posed by the lack of biomedical information. It emphasizes the importance of studying the volume and characteristics of damage around the wound channel. The paper also proposes a methodology encompassing mathematical modeling, experimental studies using non-biological simulators, and data processing techniques to investigate wound dynamics. An experimental setup with a distributed information and measurement system is presented, enabling the collection and analysis of physical parameters during penetration impacts. The structure of a distributed information-measuring system has been developed that allows recording the parameters of physical processes that occur during the penetration of a high-speed object into the simulator. The issues of receiving and transmitting data from sensors using wireless communication channels are considered. The problem of synchronization of many distributed sensors, which is important for recording the parameters of short-term processes, is analyzed in detail. An example of obtaining data when launching a high-speed object into a simulator using an electric mass accelerator within the framework of the proposed system is given. The research aims to enhance medical practices, and protective equipment design, contributing to improved treatment outcomes and patient care.
Microbiological analysis of abdominal cavity exudate, blood and affected tissues samples from patients with intra-abdominal abscesses in complicated infection of abdominal cavity
(2023) Mozgova, Yulia; Mishyna, Marina; Syplyviy, Vasyl; Ievtushenko, Olexandr; Ievtushenko, Dmytro; Marchenko, Iryna; Mishyn, Yuriy
The aim: To conduct an analysis of the results of a microbiological examination of biological samples taken from patients with intra-abdominal abscesses. Materials and methods: Material for microbiological examination was collected from 60 patients during surgery and transported to laboratory at the same day. Isolation and identification of microbial pure cultures were performed by standard microbiological methods. Statistical analysis was performed using Statistica software. Results: Analyzing the microbiological research results indicated importance of the sample collecting time (first or repeated surgery). In patient’s blood taken during first surgery it was found a statistically significant predominance of no growth of microflora. In abdominal cavity exudates anaerobic cultures increased statistically significantly in repeated surgery. It was noted that in samples taken during first surgery mixed pathogens were represented mainly by facultative anaerobic cocci, then in repeated surgery anaerobic microorganisms were predominant. Examination of liver abscess content found that monoculture was isolated in 85.7 %. Blood and affected tissue samples in such patients were sterile. Investigation of samples from patients with multiple abdominal cavity abscesses revealed anaerobic microorganisms in 16.7 %. Blood samples of that patients in 40 % were sterile. Conclusions: An analysis showed that in appendicular abscesses content gram-negatives were predominant. Gram-positive bacteria dominated in paravesical abscesses with 65 % isolates from gallbladder and 66.7 % from the affected tissue samples. In liver abscesses gram-positive cocci were isolated in 57.1 %. In multiple abdominal abscesses due to bowel perforation rod-shaped microflora was predominant (76 %) and represented by either obligate aerobes or obligate and facultative anaerobes.
Modeling of wound ballistics in biological tissues using engineering simulation software
(2022-11-04) Tsymbaliuk, V.; Lurin, I.; Gumeniuk, K.; Herasymenko, O.; Furkalo, S.; Oklei, D.; Negoduyko, Volodymyr; Gorobeiko, M.; Dinets, A.
Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds
Modern approaches to complete physical examination and treatment of patients with postoperative ventral hernias
(2014) Шевченко, Ростислав Станіславович; Шевченко, Ростислав Станиславович; Shevchenko, Rostislav; Брек, Остап Орестович; Brek, Ostap; Artamonov, R.; Gramatiuk, S.; Граматюк, Светлана Николаевна
Treatment results of 135 patients who were operated at the Surgery of Kharkov Municipal Clinical Hospital No17 during 2008-2012 were studied. Allowable radiation exposure, high degree of information content, accurate localization diagnosis, simplicity of performing ultrasound Doppler scan and computer tomography let them take a leading position in diagnosis of postoperative ventral hernias. Usage of modern techniques in examination of patients with PVHs allow to get accurate image of sizes of hernial orifices and hernial sac, expressiveness of degenerative changes in anterior abdominal wall musculo-aponeurotic structures, determine topography of epigastric vessels and characteristics of blood flow in them at preoperative stage. Diagnostic criteria described above give a surgeon the possibility to choose correctly the method of anterior abdominal wall repairing and correspondingly reduce the amount of early postoperative complications and relapses in remote period.
A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the RussoUkrainian war
(2023) Tertyshnyi, Serhii; Lurin, Igor; Khomenko, Igor; Gumeniuk, Kostiantyn; Shapovalov, Volodymyr; Nehoduiko, Volodymyr; Gorobeiko, Maksym; Dinets, Andrii
Place and role of soft tissue ultrasound examination in tourniquet syndrome
(2023-02-20) Лурін, I.А.; Хорошун, Едуард Миколайович; Негодуйко, Володимир Володимирович; Макаров, Віталій Володимирович; Тертишний, С.В.; Тірон, О.І.; Вастьянов, Р.С.
The purpose of the study was to demonstrate and analyze the possibilities of ultrasound diagnosis of tourniquet syndrome. All wounded were admitted at the Military Medical Clinical Center of the Northern Region of the Command of the Medical Forces of the Armed Forces of Ukraine from advanced surgical groups at different times from the wound with an existing tourniquet on the limb at different times after the tourniquet was placed (from 5 to 72 hours, on average 8.2±0.6). There were 32 male wounded. The average age of the wounded was 39.4±2.6 years. According to the location of the tourniquet, the wounded are distributed as follows: shoulder – 5 (15.6 %), thigh – 24 (75 %), leg – 3 (9.4 %) patients. All the wounded underwent an ultrasound and elastographic examinations. We used an average result after 12 measurements of each muscle group. When studying the data of muscle elastography against the background of the existing tourniquet, a significant difference in the elastography indicators of healthy superficial and deep muscles being under the tourniquet due to compression is noted. Elastography indicators in deep muscles are always higher than in superficial muscles. Changes in muscle elastography are localized by the location of the tourniquet. The use of ultrasound examination of soft tissues in tourniquet syndrome has an additional character. According to the data of elastography of soft tissues in the case of tourniquet syndrome, it is possible to determine the extent of soft tissue damage, which is important for determining the size of surgical intervention
Problems of healing chronic wounds
(Modern medical technology. - 2023. - №3. - С. 66-70, 2023-06-07) Babenko, N.; Бабенко, Н.М.; Litvinova, О.; Літвінова, О.Б.; Pavlov, S.; Павлов, С.Б.; Kumechko, М.; Кумечко, М.В.; Komarchuk, Viktor Vasylovych; Комарчук, Віктор Васильович
Aim. The work aimed to analyze and highlight the problems of chronic wound healing and modern methods of stimulation of reparative processes according to literature sources. An analysis of the scientific literature was carried out, in which views on the problems of wound healing are presented, taking into account the factors affecting the formation and healing of chronic wounds, and modern methods that stimulate reparation processes. Identifying the problems of wound healing will allow a comprehensive approach to the assessment of the wound process, taking into account the factors affecting the healing of injuries. Modern scientists are actively discussing the problems of wound healing, researching factors influencing the reparative process, including the high prevalence of chronic wounds, diagnosis and treatment of wound infections, age of patients, and state of immunity. In the case of systemic diseases, such as diabetes, cardiovascular pathology, etc., there is a violation of microcirculation, and as a result, there are violations of the phasing of reparative processes at the cellular level. As a result, the alteration process does not end and the process becomes chronic. In case of a mechanical injury, when adaptation reserves are reduced, primarily of the neurohumoral system, a key role is played by the disruption of regulatory mechanisms at the cellular level. Wound treatment requires surgical treatment, stimulation of angiogenesis, and other reparative processes at the systemic and local levels. In recent years, various methods of stimulating reparative processes have been used in clinical practice to treat wounds: local administration of recombinant growth factors, use of platelet-rich plasma, biotechnological wound dressings, and artificial skin substitutes. One of the most promising areas of wound treatment is the development of methods for targeted activation of stem cells. However, there are still insufficient data for the practical application of this method. Clinically effective and safe methods are still being developed. Physical methods are promising for improving the healing of chronic wounds. However, the selection of optimal parameters for physical action continues to be an urgent task. Despite the positive results obtained using the methods described above, there is a need for additional experimental studies and randomized controlled trials. Conclusions. Chronic wounds develop as a result of severe systemic diseases, and major mechanical injuries against the background of a decrease in physiological reserves due to emotional and psychological stress, obesity, etc. Choosing the right method of influencing the reparative process, taking into account the leading mechanism of damage repair, becomes very important to ensure the best chance for optimal wound healing.
Prospects of the high-speed multimedia data transmission technologies use in the structure of the system for providing aid to injured persons having a gunshot defect of soft tissues
(2023) Lurin, I.; Khomenko, I.; Nehoduiko, Volodymyr; Tertyshnyi, S.; Weiss, B.; Kvasnevskyi, E.; Kvasnevskyi, O.
The aim: To improve the results of providing medical care in the conditions of a fullscale war in Ukraine due to the use of medical technologies Materials and methods: From the first days, the Military Medical Clinical Center of the Southern Region provided medical assistance to the persons wounded as a result of the Russian Federation’s armed aggression. The presented multidisciplinary observation includes data received from 24.02.22 to 26.05.22. During this term, the multidisciplinary team assisted by the Teladoc Health system (the connection between the Charite Clinic, Berlin, and the MMCC of the Southern Region, Ukraine) performed 39 reconstructive and remedial operations in the MMCC of the Southern Region (Department of Surgical Infection). Results: It has been found that the implementation of differentiated surgical tactics (developed in cooperation between Charite clinics, Berlin, and MMCC of the Southern Region, Ukraine, using the Teladoc health system) in wounded patients with gunshot defects of soft tissues at the III and IV levels of medical care improves functional results, increases indicators of satisfactory from 46.9 % to 53.7 %, reducing the relative number of unsatisfactory from 18.8 % to 11.6 %. Conclusions: The information exchange in the Teledoc Health system is performed in telephone mode through protected communication channels. It enabled real-time treatment strategy recommendations and improved functional outcomes, increasing 2 the satisfactory rate from 46.9 % to 53.7 %, and reducing the relative unsatisfactory rate from 18.8 % to 11.6 %.
Retrieval of ferromagnetic fragments from the lung using video-assisted thoracoscopic surgery and magnetic tool: a case report of combat patient injured in the war in Ukraine
(2023-08-24) Lurin, I.; Khoroshun, Eduard; Negoduiko, Volodymyr; Makarov, Volodymyr; Shypilov, Serhii; Boroday, V.; Gorobeiko, M.; Dinets, А.
Background Gunshot wounds injury to the thorax is common in armed conficts or war, including the war of Russia against Ukraine. Injury to the chest is associated with a high mortality or physical disability due to damage to the lungs, heart, and major vessels. The aim of this report is to demonstrate a case of successful management of severe gunshot injury to the lungs using video-assisted thoracoscopic surgery and magnetic tool for a combat patient injured in the war in Ukraine. Case presentation A 51-year-old soldier of the Armed Forces of Ukraine received a gunshot injury due to shelling from artillery strikes in the Donbas battlefeld area. After evacuation to Level II, a forward surgical team performed primary surgical debridement. Two hours after the injury, the patient was evacuated to the Level IV of medical care (Kharkiv). At Level IV, a CT scan showed penetrating gunshot wounds to the left part of the chest with injury to the upper lobe of the left lung with the presence of the 2 metal fragments of the artillery projectile with the size of 2.5×2.0 cm and 1.0×1.0 cm. These two fragments were removed by using video-assisted thoracoscopic surgery (VATS) using the inlet gunshot hole in the left lateral chest area, as well as the assistance of a magnetic tool. Conclusions VATS and magnetic technologies should be considered for hemodynamically stable combat patients with a gunshot injury to the lungs in the ongoing war. Each combat patient could be treated by individualized approach such as using the wound canal as a scope port after primary surgical debridement of the wound and antibiotic prophylaxis
The role of adipose tissue cell elements in the regulation of the nitroxidergic system and possible ways of pharmacological modulation
(2024-03-13) Bielenichev, I.; Maslennikov, S.; Dobrelia, N.; Khromov, O.; Holovakha, M.; Ryzhenko, V.; Brek, Ostap
Endothelial dysfunction is characterized by a decrease in the bioavailability of the vasodilator – nitric oxide (NO), and an increase in the level of vasoconstrictor substances. This imbalance leads to vasoconstriction, leukocyte attachment and inflammatory reactions in the vascular wall, atherosclerosis and thrombosis. The aim: to evaluate the role of adipose tissue elements in the regulation of parameters of the nitroxidergic system under hypoxia conditions. Materials and methods. The studies were carried out on 30 adult white male Wistar rats. All animals were randomly assigned and divided into groups: a control group (15 rats), type 2 diabetes mellitus (T2DM) was induced in the animals of the second group (15 rats). Isolated fragments of the popliteal arteries (PA) and intrapulmonary artery (IPA) were cleared of perivascular adipose tissue (PVAT-) or left uncleaned (PVAT+) and cut into rings. The simulation of acute hypoxia with further study of medical agents were performed. Results. The PA and IPA with PVAT responded to acute hypoxia with vasoconstriction – an increase in the amplitude of contraction in the first and second phases, and after removing PVAT, they responded with a decrease in the maximum amplitude of contraction by 3.4 times in the 1st phase and an increase in amplitude by 1.8 times in the 2nd phase. Perfusion with Angiolin reduced 2nd phase of HV of the PA and IPA. Adding a combination of Thiotriazoline and L-arginine (1:4) to a solution for perfusion of fragments of arteries of animals with T2DM, causes a significant increase in constrictor reactions in both the 1st and 2nd phases of HV, regardless of presence of perivascular adipose tissue. Conclusions. The presence of PVAT affects the HV of arteries, both in normal and in T2DM. The possibilities of ways of pharmacological modulation of the nitroxidergic system depending on the state of PVAT were determined.
Soft tissue perfusion evaluation algorithm in the scheme of gunshot defects “closure”
(2023) Khomenko, I.; Lurin, I.; Nehoduiko, Volodymyr; Tertyshnyi, S.; Popova, O.; Vastyanov, R.; Weis, B.
The purpose of the study was to determine indicators for the soft tissue perfusion evaluation in the scheme of gunshot defects “closure” using a variety of flaps from V–Y and Keystone till “propeller” and free flaps. A thermal imaging camera FLIR C2 with an integrated temperature gauge was used to obtain thermometric images together with a digital photograph of the scanned anatomical area. Microcirculation in damaged tissues plays an important role in wound substrate and the future flap in certain anatomical structure viability ensuring. That’s why its important to determine the features of the soft tissues perfusion fire transformation and the place of the corresponding blood supply from where it is possible to “raise” the flap in the future. The original dynamic multimodal concept using DDT and sonographic evaluation of soft tissue perfusion allows to look at the specific gunshot wound changes in a new way and to plan strategically the optimal path of reconstructive-plastic recovery. The thermographic and sonographic criteria uniqueness forsoft tissue perfusion assessing in the context of large gunshot defects closing are reliable and objective, allow to assess the condition of the future wound bed and edges. They can be used not only to evaluate the wound before closing the defect but also to correct further tactics in the large defects or wounds treatment that do not heal for a long time

Browse

Browsing Наукові праці. Кафедра хірургії № 4 by Title